UNIVERSITY  of  •  '•  •  <^<^ORNIA 

A'l 

LOS  ANGELES 

LIBRA^RY 


THE    MENTAL    HEALTH    OF   THE 
SCHOOL    CHILD 


?8? 


THE    MENTAL   HEALTH 
OF  THE  SCHOOL  CHILD 


THE   PSYCHO-EDUCATIONAL   CLINIC   IN 
RELATION  TO  CHILD  WELFARE 

CONTRIBUTIONS    TO    A    NEW    SCIENCE 

OF    ORTHOPHRENICS    AND 

ORTHOSOMATICS 


Br 
J.   E.   WALLACE  WALLIN,   Ph.  D. 

Professm-  of  Clinical  Psychology  and  Director 

of  Psycho-Educational  Clinic,  School  of 

Education,  University  of  Pittsburgh 

Director-Elect   of  Psycho- Educational    Clinic 

St.  Louis  Public  Schools 


New  Haven:  Yale  University  Press 

London  :  Humphrey  Milford 

Oxford  University   Press 

MDCCCCXIV 


Copyright,  1914,  by 
Yale  University  Press 


First  printed  June,  1914,  1000  copies 


To 

G.   STANLEY  HALL 

Founder  of  the  Modern  Child  Study  Movement 

AND 

The  World's  Second   Psychological   Laboratory 


PREFACE 

The  publication  of  these  papers  and  addresses  in  a 
single  volume  was  prompted,  first  of  all,  by  the  widespread 
interest  which  is  rapidly  manifesting  itself  in  all  sections 
of  the  country  in  the  grave  social  and  educational  prob- 
lems which  spring  from  the  presence  in  every  populous 
community  of  large  numbers  of  mentally  abnormal  chil- 
dren. It  is  now  generally  recognized  that  many  of  the 
most  vexatious  problems  in  our  present-day  social  economy 
are  somehow  bound  up  with  the  mental  and  educational 
abnormalities  of  childhood.  Educators,  physicians,  sociolo- 
gists, penologists,  criminologists,  lawyers,  clergymen,  phi- 
lanthropists and  parents,  therefore,  welcome  any  attempt 
to  gain  deeper  scientific  insight  into  the  nature,  extent 
and  causes  of  the  mental,  moral  and  educational  arrest, 
deviation  or  deficiency  of  cliildren.  The  papers  included 
in  tliis  collection  aim  to  show  in  slight  measure  the  aid 
which  the  practical  psychologists  and  expert  educational 
consultants  hope  to  render  in  the  important  work  of  diag- 
nosing, identifying,  studying  and  training  feeble-minded, 
backward  and  mentally  abnormal  cliildren  in  the  schools. 

During  the  last  three  or  four  years  the  writer  has  pub- 
lished a  number  of  experimental  memoirs,  articles  and 
addresses  in  American  and  European  periodicals  dealing, 
from  different  points  of  view,  with  a  common  theme :  the 
scientific  study  and  the  care  and  improvement  of  the 
mental  and  physical  misfits  in  the  schools,  or,  in  a  word, 
the  conservation  of  cliild  life.  These  studies  when  brought 
to  a  focus  form  a  fairly  unitary,  but  by  no  means  a  sym- 


viii  PREFACE 

metrical  or  systematic,  whole.  The  more  systematic 
treatment  of  the  study  and  training  of  mentally  unusual 
children  is  reserved  for  later  volumes.  A  practical  motive 
for  bringing  together  the  studies  of  this  volume  is  the 
fact  that  the  demand  for  reprints  has  exhausted  the  supply 
of  several  of  the  articles. 

Most  of  the  chapters  of  the  book  are  reprinted,  with  the 
kind  permission  of  the  editors,  from  various  periodicals. 
Several  of  the  reprints,  however,  have  been  so  completely 
revised  that  they  constitute,  in  effect,  new  contributions, 
while  the  new  chapters  added  contain  important  data 
wliich  have  recently  been  gathered  at  first-hand  and  which 
are  nowhere  else  available. 

A  certain  amount  of  repetition  is  ordinarily  unavoid- 
able in  the  pubhcation  of  a  series  of  scattered  studies  which 
deal  with  very  closely  related  topics.  While  many  articles 
have  been  considerably  abbreviated  and  others  somewhat 
expanded — sometimes  to  the  detriment  of  the  unity  of 
the  individual  articles — in  order  to  avoid  needless  itera- 
tion, certain  repetitions  have  been  designedly  retained, 
because  there  exist  today  among  both  lay  and  professional 
workers  serious  and  widespread  misapprehensions  regard- 
ing the  aims,  functions  and  administrative  affiliations  of  the 
psychological  or  psycho-educational  clinic,  regarding  the 
qualifications  of  Binet  testers,  amateur  psychologists, 
professionally  trained  clinical  psychologists,  'special' 
teachers,  nurses  and  physicians.  Owing  to  these  miscon- 
ceptions we  are  today  tolerating  and  fostering  a  type  of 
work  in  appUed  psychology  wliich  often  is  scientifically 
barren  and  sometimes  positively  pernicious.  Clinical  psy- 
chology promises  to  make  a  very  important  contribution 
to  the  world's  sum  total  of  knowledge,  but  it  is  in  its 
infancy,  and,  therefore,  its  development  needs  to  be  guided 


PREFACE  ix 

into  channels  that  are  in  accord  with  the  highest  stand- 
ards of  scientific  work.  In  view  of  the  present  situation — 
a  situation  which  in  many  sections  allows  almost  anyone 
to  pose  as  a  psychological  or  educational  diagnostician — 
I  beheve  that  no  apology  is  necessary  for  the  repetitions 
which  have  been  retained  in  this  series  of  selected  papers, 
or  for  the  emphasis  which  I  have  given  my  most  cherished 
convictions. 

J.  E.  W.  W. 
January,  1914. 


CONTENTS 

Preface        ........  vii 

Chapter  I 

Medical    and    Psychological    Inspection    of    School 

Children 1 

Chapter  II 

The    New    Clinical    Psychology    and    the    Psycho- 

clinicist  .......  22 

Chapter  III 
M^linical  Psychology:  What  It  Is  and  What  It  Is  Not  121 

Chapter  IV 
The  Functions  of  the  Psychological  Clinic         .  .  137 

Chapter  V 

The  Distinctive  Contribution  of  the  Psycho-educa- 
tional Clinic  to  the  School  Hygiene  Movement  .  156 

Chapter  VI 
Human   Efficiency  .  .  .  .  .  .  166 

Chapter  VII 

Eight  Months  of  Psycho-clinical  Research  at  the  New 
Jersey  State  Village  for  Epileptics,  with  Some 
Results  from  the  Binet-Simon  Testing        .  .  182 

Chapter  VIII 

The  Present  Status  of  the  Binet-Simon  Graded  Tests 

of  Intelligence        .  .  .  .  .  .  196 


xii  CONTENTS 

Chapter  IX 

Current  Misconceptions  in  Regard  to  the  Functions  of 
Binet  Testing  and  of  Amateur  Psychological 
Testers 209 

Chapter  X 

Re-averments  Respecting  Psycho-clinical  Norms  and 

Scales  of  Development   .  .  .       "    .  .  216 

Chapter  XI 
Individual  and  Group  Efficiency      .  .  .  .  231 

Chapter  XII 

The  Euthenical  and  Eugenical  Aspects  of  Infant  and 

Child  Orthogenesis  .....  246 

Chapter  XIII 

Experimental  Oral  Orthogenics:  an  Experimental 
Investigation  of  the  Effects  of  Dental  Treat- 
ment on  Mental  Efficiency        ....  275 

Chapter  XIV 

The  Relation  of  Oral  Hygiene  to  Efficient  Mentation 

in  Backward  Children    .  .  .  .  .  291 

Chapter  XV 

Methods  of  Measuring  the  Orthophrenic   Effects  of 

the  Removal  of  Physical  Handicaps  .  .  .  300 

Chapter  XVI 

Medical    and    Dental    Inspection    in    the    Cleveland 

Schools 315 


CONTENTS  xiii 

V  Chapter  XVII 

Efficiency  in  School  Organization  and  the  Conserva- 
tion of  the  Mental  Health  of  Children        .  .  337 

Chapter  XVIII 

Public     School     Provisions     for     Mentally     Unusual 

Children 383 

Chapter  XIX 

A  Schema  for  the   Clinical  Study  of   Mentally  and 

Educationally  Unusual  Children         .  .  .  429 

Note  to  Chapter  IV 447 

Index  ....  .  .  .  .451 


CHAPT^T)  T 


7 


MEDICAL    AND    PS  i  CHOLOGICAL    INSPECTION 
OF  SCHOOL  CHILDREN^ 

The  question  as  to  the  need  of  the  inspection  of  school 
children  for  the  detection  of  contagious  and  communicable 
diseases  {^e.g.,  diphtheria,  scarlet  fever,  measles,  whooping^ 
cough,  chicken  pox,  smallpox,  tuberculosis)  may  be  said 
to  be  closed.  All  intelhgent  observers  are  agreed  that 
the  schools,  unless  properly  medically  supervised,  may,  and 
frequently  do,  become  virulent  foci  for  the  dissemination  of 
fatal  community  diseases.  As  a  matter  of  fact,  all 
enlightened  urban  communities  in  this  country  and  in 
Europe  have  recognized  this  imperative  need  by  providing 
some  form  of  school  inspection  for  the  contagious  child 
diseases.  The  modern  school  medical-inspection  movement, 
indeed,  began  as  a  form  of  inspection  for  infectious  dis- 
eases by  officers  of  Boards  of  Health. 

But  there  is  another  function  of  school  medical  inspec- 
tion which  is  even  more  important  for  the  proper  develop- 
ment of  the  inchvidual  child,  though  this  function  is  not  so 
generally  recognized ;  namely,  the  physical  examination  of 
school  children  for  the  detection  of  physical  defects :  de- 
fective vision,  defective  hearing,  defective  nasal  breathing, 
adenoids,  hypertrophied  tonsils,  cardiac  diseases,  defective 
teeth  and  palate,  malnutrition,  orthopedic  defects,  tuber- 
cular lymph  nodes,  lateral  curvature  of  the  spine,  stoop 

1  Reprinted,  with  extensive  alterations,  from  The  Western  Journal 
of  Education  (now  The  American  School  Master),  1909,  pp.  433-446. 


2        MENTAL  HEALTH  OF  SCHOOL  CHILD 

shoulders,  nervous  exhaustion  and  pulmonary  disease. 
We  are  just  awakening  to  the  necessity  of  this  type  of 
pupil  inspection  because  we  are  just  beginning  to  realize 
the  extent  to  which  ^children  are  physically  handicapped. 
The  statistics  of  defective  children,  wherever  gathered,  are 
fairly  appalling.  Space  permits  reference  to  only  a  few 
American  surveys. 

Of  more  than  5,000  school  children  examined  in  Los 
Angeles,  61  per  cent  suffered  from  defective  eyesight,  31 
per  cent  from  adenoids,  25  per  cent  from  enlarged  tonsils 
and  22  per  cent  from  defective  hearing.  In  Chicago  in 
1909,  123,900  children  were  examined  (this  was  not  an 
ultimate  examination,  only  the  major  defects  being 
noticed),  and  of  these  36  per  cent  had  defective  teeth,  22 
per  cent  enlarged  tonsils,  13  per  cent  enlarged  glands,  5.5 
per  cent  nasal  defects,  3.5  per  cent  adenoids  and  2.3  per 
cent  hearing  defects.  In  another  examination  of  3,963 
children  in  the  same  city  60  per  cent  were  said  to  need  the 
attention  of  a  physician,  the  most  prominent  defects  re- 
quiring treatment  being  hypertrophied  tonsils,  enlarged 
glands  and  adenoids.  Seventy-two  and  three-tenths  per 
cent  of  230,243  children  examined  in  New  York  City  in 
1911  were  reported  as  requiring  treatment.  The  per- 
centages of  defects  found  were  as  follows :  Defective  teeth, 
59  per  cent;  hypertrophied  tonsils,  15  per  cent;  defective 
nasal  breathing,  11.9  per  cent;  defective  vision,  10.6  per 
cent ;  malnutrition,  2.5  per  cent ;  cardiac  disease,  .7  per 
cent;  defective  hearing,  .6  per  cent;  orthopedic  defects, 
.5  per  cent ;  chorea,  .4  per  cent ;  pulmonary  disease,  .4 
per  cent;  tubercular  lymph  nodes,  .2  per  cent.  Of  1,442 
children,  largely  of  Irish,  Jewish  and  Italian  stock, 
examined  in  three  schools  in  this  city  in  1908,  73  per  cent 
suffered   from    defective   teeth,   59    per   cent    from   nasal 


INSPECTION  OF  SCHOOL  CHILDREN  3 

breathing,  42  per  cent  from  visual  defects,  39  per  cent 
from  hypertrophied  tonsils  and  15  per  cent  from  anemia. 
Based  upon  another  medical  census  of  23,000  children  in 
all  grades,  the  following  distribution  was  found  at  the  ages 
of  six  and  fifteen: 

At  6  years  At  15  years 

Defective  teeth 65  per  cent  31  per  cent 

Enlarged  tonsils    40  14 

Enlarged  glands    40  7 

Adenoids     23  3 

Defective  breathing    23  9 

Defective  vision 17  26 

About  80  per  cent  of  these  children  were  physically  defect- 
ive in  some  way.  Gland,  mouth  and  throat  troubles,  it 
will  be  observed,  are  typical  childhood  infirmities,  while 
defective  vision  (as  well  as  defective  teeth)  constitutes  the 
bane  of  youth.  In  Worcester,  758  pupils  examined  in 
two  elementary  schools  showed  enlarged  glands  in  64.5 
per  cent  of  the  cases,  affected  tonsils  in  37  per  cent,  ade- 
noids ('suspected')  in  21  per  cent,  eye  defects  in  15  per 
cent,  anemia  in  4.5  per  cent,  poor  nutrition  in  5.5  per  cent, 
medium  nutrition  in  36  per  cent  and  good  nutrition  in 
57.5  per  cent.  Decayed  teeth  Avere  found  in  86.5  per  cent 
of  the  pupils,  the  average  number  per  child  being  4.85,  and 
the  corresponding  averages  in  the  different  grades  (given 
in  order  from  the  first  to  the  ninth  grade),  7,  6.54,  6.08, 
4.90,  4,  3.50,  4,  4  and  3.66  per  pupil.  There  is  a  noticeable 
falling  off  in  the  five  upper  grades.  The  figures  show  a 
wide  variation  from  grade  to  grade  in  some  of  the  defects. 
Of  over  50,000  pupils  examined  in  the  public  schools  of 
Cleveland,  62.5  per  cent  suffered  from  one  or  more  physical 
defects;  and  of  1,284  pupils  examined  in  about  equal 
numbers    in    a    congested    section    and   in    the    east    end 


4        MENTAL  HEALTH  OF  SCHOOL  CHILD 

(where  the  living  conditions  were  more  favorable),  18.5 
per   cent  of  the   former  suffered   from  various   kinds   of 
defects  as  against  28.4  per  cent  of  the  latter.     Of  156 
pupils    examined  in   the   seven   grades    of   the   school   of 
observation   connected   with   the    Summer   School    of   the 
University  of  Pennsylvania,  38.5  per  cent  had  decayed 
teeth,  20.5  per  cent  suffered  from  eyestrain,  13.5  per  cent 
from  nasal  obstruction,  5.1  per  cent  from  defective  hearing 
and  enlarged  tonsils,  4.5  per  cent  from  poor  nutrition  and 
2  per  cent  from  nervous  exhaustion  and  stoop  shoulders. 
It  may  be   assumed   that  these   children   came   from   the 
better  social  ranks.     A  survey  of  a  special  class  of  41 
Philadelphia    retardates — these    pupils    assumedly    came 
from  the  lower  social  strata — yielded  48.7   per  cent   of 
eye  defects,  34  per  cent  of  defective  speech,  26.8  per  cent 
nose  and  throat  troubles,  19.5  per  cent  nervous  tempera- 
ments,  17  per  cent  each  of  orthopedic   defects,   lack   of 
motor    control    and    hearing    defects.      Of    the    children 
examined  in  Jefferson  City,  Missouri,  for  eye,  nose  and 
throat  troubles,  41  per  cent  were  in  need  of  glasses,  while 
7.7  per  cent  had  defective  hearing,  usually  in  one  ear. 
In  the  rural  districts  of  St.  Louis  County,  30.6  per  cent 
of  the  2,000  cases  examined  had  subnormal  visual  acuity  in 
one  or  both  eyes,  14  per  cent  had  less  than  two-thirds  nor- 
mal vision  and  3  per  cent  less  than  one-half  normal  vision 
(these  figures  do  not  include  hyperopia  or  mild  astigmat- 
ism), 7  per  cent  had  defective  hearing  in  either  of  the  ears, 
somewhat  less  than  2  per  cent  could  not  hear  a  whisper  with 
either  ear  and  .9  per  cent  were  seriously  troubled  with 
adenoids.      From   a   study   of  twenty-five  Massachusetts, 
New  York  and  New  Jersey  cities  Rapeer^  estimates  that 
the   percentages    of   serious    defects    requiring   treatment 
2  Rapeer.     School  Health  Administration,  New  York,  1913,  p.  226. 


INSPECTION  OF  SCHOOL  CHILDREN  5 

among  elementary  pupils  are  as  follows :  dental  defects,  66 
per  cent ;  visual  defects,  7  per  cent ;  enlarged  tonsils,  6 
per  cent ;  adenoids  and  nasal  obstruction,  5  per  cent ;  mal- 
nutrition 2  per  cent ;  anemia  and  enlarged  glands,  1  per 
cent ;  spinal  curvature,  .8  per  cent ;  strabismus,  .7  per  cent ; 
hearing  defects  and  weak  lungs  (not  tuberculosis),  .5  per 
cent  and  nervousness,  .2  per  cent.  (See  also  Chapter 
XVI.) 

School  medical  inspection  statistics,  which  are  now 
available  from  the  examination  of  millions  of  pupils  in  all 
sections  of  the  country,  show  clearly — in  spite  of  the 
unreliability  of  many  of  the  reports — that  physical 
defects  in  children  are  not  restricted  to  any  clime,  race, 
environment  or  social  condition.  The  children  in  sunny 
Southern  California  no  less  than  the  children  of  the  cold 
or  humid  North,  East  and  West,  the  children  of  the  coun- 
try no  less  than  the  children  of  the  city,  the  cliildren  of 
the  rich  no  less  than  the  children  of  the  poor,  labor  under 
various  forms  of  physical  handicap  which  are  usually 
subject  to  melioration  or  cure.  It  is  impossible  to  esti- 
mate the  percentage  of  physically  defective  pupils  even 
with  approximate  accuracy,  because  the  standards  of  the 
examiners  differ  very  widely  and  because  some  defects 
increase  with  age  while  others  decrease.  Any  reliable 
inspection  surveys  must  be  made  in  relation  to  age.  My 
own  estimates,  based  on  the  study  of  numerous  statistical 
surveys,  of  the  percentage  of  grade  pupils  seriously 
affected  with  various  defects  are  as  follows :  defective  teeth 
(one  or  more  cavities,  serious  malocclusion),  from  50  to 
95  per  cent ;  defective  vision  and  adenoids  and  nasal 
obstruction,  from  5  to  20  per  cent ;  seriously  enlarged  or 
diseased  tonsils,  5  to  15  per  cent ;  curvature  of  the  spine, 
2  to  7  per  cent ;  malnutrition,  1  to  6  per  cent ;  weak  or 


6        MENTAL  HEALTH  OF  SCHOOL  CHH.D 

tubercular  lungs  and  defective  hearing,  1  to  2  per  cent.  It 
is  estimated  that  12,000,000  of  the  pupils  in  the  public 
schools  of  the  country  are  to  some  extent  handicapped  by 
one  or  more  physical  defects.  The  typical  American  school 
child  in  the  grades  everywhere  suffers  more  or  less  from 
some  form  of  physical  defectiveness.  Sometimes  the 
defects  are  so  numerous  and  serious  that  the  child's  body  is 
but  a  tissue  of  malfunctioning,  misshapen,  diseased  or 
disordered  organs. 

The  defective  condition  of  the  physiques  of  our  pupils 
must  be  a  matter  of  very  serious  moment  to  all  people  who 
have  the  welfare  of  children  at  heart.  The  parent  cannot 
fail  to  be  concerned  about  conditions  which  cause  dis- 
comfort, restlessness,  pain  or  disease  in  his  children.  The 
school  administrator  and  teacher  must  be  vitally  inter- 
ested in  any  conditions  which  may  cause  irregular  attend- 
ance or  impair  the  pedagogical  efficiency  of  the  learner. 
Likewise  the  city  and  the  state,  because  they  have  made 
large  investments  in  school  plants  and  school  parapher- 
nalia and  have  appropriated  large  sums  for  the  support 
of  teachers,  have  vital  interests  at  stake  which  must  be 
rigorously  conserved.  They  have  set  children  apart  for 
a  long  term  of  years  and  have  thereby  denied  them  the 
opportunities  of  engaging  in  productive  labor.  This  they 
have  done  in  order  to  provide  for  the  children  such  mental 
and  bodily  training  as  will  eventually  so  increase  their 
productive  capacity  as  to  insure  them  increased  returns 
upon  their  investment  of  time  and  energy.  In  order  to 
guarantee  its  own  perpetuity  the  state  demands  an  output 
from  the  schools  that  shall  manifest  a  capacity  for  social 
and  industrial  efficiency,  and  any  obstacle  to  the  attain- 
ment of  this  end  must  be  removed.  The  state  demands,  as 
of  right,  that  it  secure  adequate  returns  upon  the  invest- 


INSPECTION  OF  SCHOOL  CHILDREN  7 

ment  of  money  and  human  sacrifice  which  it  has  made  in 
the  interest  of  the  schools. 

But  are  the  schools  under  existing  conditions  able  to 
meet  this  just  demand  imposed  upon  them  by  the  state? 
Manifestly  not,  for  numerous  investigations  have  shown 
that  there  is  a  veritable  army  of  handicapped  pupils  in  the 
schools  who  are  unable  properly  to  profit  by  the  instruc- 
tion. The  slow-progress  pupils  outnumber  the  accelerated 
pupils  eight  to  ten  times  (the  average  for  twenty-nine 
cities),  while  over  one-third  of  all  the  elementary  pupils 
are  pedagogically  retarded  (see  also  Chapter  II).  A 
certain  amount  of  this  pedagogical  retardation  is  un- 
doubtedly due  to  physical  defectiveness.  This  would  seem 
to  be  so  on  a  priori  grounds,  for  the  body  and  the  mind 
are  indissolubly  knit  together.  They  are  merely  two 
aspects  of  the  same  unitary  life  process.  There  can  be  no 
psychical  activity  without  a  correlated  physical  activity, 
no  psychosis  without  a  correlated  neurosis.  When  the 
physical  machine  is  crippled  the  mental  mechanism  cannot 
as  a  rule  work  harmoniously.  Rarely,  perhaps,  does  the 
mind  reach  its  highest  potential  so  long  as  the  bodily 
organs  function  defectively.  It  is  impossible  by  ordinary 
school  processes  to  make  defective  sense  organs  to  function 
properly.  That  physical  defects  often  constitute  a  posi- 
tive deterrent  to  normal  mental  action  and  thus  produce 
pedagogical  retardation  has  been  shown  by  various  obser- 
vations and  statistical  and  experimental  studies.  Those 
studies  are  discussed  at  length  in  Chapter  XV  (which 
see). 

It  is  true  that  in  some  investigations  no  marked  corre- 
lation between  physical  defects  and  retardation  in  school 
progress  has  been  found.  This  may  sometimes  be  due  to 
the  fact  that  the  dull,  physically  defective  child  has  been 


8        MENTAL  HEALTH  OF  SCHOOL  CHILD 

pushed  along  irrespective  of  his  merits,  or  to  the  fact 
that  the  progress  of  the  whole  class  has  been  adjusted  to 
meet  his  needs ;  or  the  factor  of  age  has  complicated  the 
question;  or  physical  defects  have  been  included  which 
exert  no  influence  upon  neuronic  and  mental  development. 
But  it  is  certain  that  one  of  the  causative  factors  of 
retardation  and  elimination  (retardation  usually  results 
in  elimination)  is  physical  defectiveness. 

Not  only  so :  the  physically  defective  child  tends  to 
become  the  juvenile  criminal.  For  the  physically  defect- 
ive, who  tends  to  make  the  dullard,  becomes  dissatisfied 
with  himself  and  discouraged  with  his  school  work  and  thus 
plays  truant  or  permanently  drops  out  of  school.  In  one 
investigation  over  95  per  cent  of  truants  were  found  to 
have  physical  defects.  In  many  cases  these  eliminated 
physical  defectives  become  the  street  vagrants  or  loafers ; 
and  the  loafers  are  the  embryo  criminals.  Ninety  per  cent 
of  criminals  began  their  careers  as  truants  or  loafers, 
according  to  A.  J.  Pillsbury.  Undoubtedly  there  is  fre- 
quently a  direct  relation  between  physical  defectiveness 
and  moral  perversity  and  youthful  criminality.  Much 
precocious  criminality  is  traceable  to  physiological  mal- 
adjustment. 

The  physical  examination  of  school  children  would  thus 
seem  to  be  one  of  the  important  present-day  public  duties. 
It  is  false  economy  to  allow  the  progress  of  whole  classes 
to  be  impeded  by  the  presence  of  pupils  whose  physical 
defects  make  it  impossible  for  them  to  keep  step  with  the 
normal  procession.  The  mere  removal  of  a  physical 
obstruction  will  sometimes  revolutionize  the  life  liistory  of 
a  child,  while  years  of  mental  training,  with  all  their 
attendant  strain  and  depression  may  accomplish  practi- 
cally nothing  for  physically  handicapped  children.     The 


INSPECTION  OF  SCHOOL  CHILDREN  9 

f.rst  step  in  mental  training  should  be  the  removal  of  those 
physical  obstructions  which  stand  in  the  way  of  the  free, 
spontaneous  activity  of  the  mind.  Nor  is  this  work  needed 
for  the  sake  of  the  self-protection  of  the  classroom ;  society 
must  assume  the  work  for  the  sake  of  its  own  self-protec- 
tion. A  child  abnormal  in  body  probably  cannot  remain 
normal  in  mind;  he  will  tend,  as  has  been  said,  to  become 
morally  perverse  and  criminal.  Civilization  is  thus  coming 
to  face  a  new  menace  in  the  presence  of  rapidly  multiplying 
multitudes  of  physically  defective  children  in  every  com- 
munity. Instead  of  penalizing  and  trying  to  reform  the 
child  after  he  has  developed  his  degenerate  tendencies  and 
committed  his  offense,  would  it  not  be  more  sane  for 
society  to  turn  right  face  about  and  remove  one  of  the 
causes  of  the  young  child's  perverse  tendencies  before  the 
latter  have  become  ineradicably  ingrained  ?  This  can  only 
be  done  through  the  school  medical  clinic  and  dispensary. 
The  day  will  come  when  the  first  thing  the  schools  will  do 
for  the  first-day  entrant  will  be  to  give  him  a  thorough 
physical  examination.  'First  the  natural ;  afterward  the 
spiritual.' 

That  the  American  public  is  rapidly  becoming  awake  to 
the  necessity  of  providing  for  the  inspection  of  physical 
defects  in  school  children  is  apparent  on  every  hand. 
Although  school  medical  inspection  started  in  this  country 
only  about  nineteen  years  ago  (Boston  appointed  fifty 
school  physicians  in  the  fall  of  1894;  Chicago  followed  in 
1895,  New  York  in  1897  and  Philadelphia  in  1898),  and 
although  thirteen  years  ago  only  eight  cities  had  estab- 
lished medical  departments  in  the  schools  (but  without 
the  school  nurse),  the  development  has  been  so  rapid 
during  the  last  decade  that  in  1911  443  cities  (or  42  per 
cent)   of  1,038  cities  reporting  were  supporting  depart- 


10      MENTAL  HEALTH  OF  SCHOOL  CHH.D 

merits  of  school  medical  inspection  or  school  hygiene  (but 
only  214  were  providing  'physical  examination  by  doc- 
tors')— this  according  to  a  report  of  the  Russell  Sage 
Foundation — while  in  1912  nine  states  had  mandatory 
laws  and  ten  states  had  permissive  laws  in  regard  to  school 
health  work.  Nevertheless,  fully  half  of  the  cities  of  the 
country  are  either  making  no  provisions  whatsoever  or 
very  inadequate  provisions  for  the  routine  physical  exami- 
nation of  school  children,  while  the  rural  districts  are 
doing  practically  nothing  (Minnesota,  Michigan  and 
Virginia  employ  specialists  to  visit  the  rural  schools,  in 
order  to  instruct  teachers  in  school  and  child  hygiene). 
Very  few  school  systems  conduct  dental  and  medical  dis- 
pensaries for  the  free  treatment  of  certified  indigent  chil- 
dren, while  only  seventy-six  cities  (in  1911)  supported 
staffs  of  school  nurses  and  eighty-nine  cities  employed 
school  dentists.  VV^e  are  still  lagging  behind  Europe, 
where  the  school  physical  examination  work  had  its  incep- 
tion (Sweden  appointed  school  physicians  for  every 
secondary  school  in  1868,  France  organized  departments 
of  medical  inspection  in  1879,  while  Germany  followed  in 
1889),  and  where  it  has  been  organized  in  some  countries 
as  a  function  of  the  national  government,  notably  in 
France,  Germany,  England,  Norway,  Belgium,  Switzer- 
land and  Sweden.  In  England  and  Wales  the  Education 
Act  of  1907  makes  school  medical  inspection  compulsory 
and  universal  (even  in  the  most  remote  rural  districts). 
The  work  is  conducted  by  317  local  educational  authorities, 
who  employ  943  school  medical  officers,  and  is  under  the 
administrative  control  of  the  Chief  Medical  Officer  of  the 
Board  of  Education  for  England  and  Wales.  Every  child 
is  given  a  routine  physical  examination  at  the  time  of 
entering  and  leaving  school  (an  intermediate  examination 


INSPECTION  OF  SCHOOL  CHILDREN        11 

at  the  age  of  eight  will  be  required  after  April  1,  1915), 
which  includes  an  examination  of  the  special  sense  organs, 
the  heart,  lungs,  lymphatic  system,  height,  weight  and 
personal  and  family  history.  Not  only  so,  in  1913  the 
educational  authorities  had  estabUshed  ninety-five  medical 
clinics  and  fifty-eight  dental  clinics  for  the  free  treatment 
of  minor  ailments  and  physical  defects  (exclusive  of 
thirty-eight  cUnics  which  provide  X-ray  treatment  for 
ringworm). 

The  campaign  for  the  establishment  of  school  medical 
and  dental  clinics  in  the  United  States  must  go  on  until  the 
work  has  been  made  compulsory  and  universal.  Not  only 
so,  dispensary  dental  and  medical  clinics  should  be  estab- 
lished by  schools  for  the  free  treatment  of  certified  indi- 
gents, and  nurses  should  be  appointed  for  examination  and 
follow-up  work,  for  treating  and  instructing  the  affected 
pupils  and  for  socio-hygienic  service  in  the  homes.  For 
the  work  of  diagnosis  will  be  largely  worthless  unless  the 
correction  or  mitigation  of  defects  can  be  secured.  More- 
over, it  is  not  sufficient  merely  to  mitigate  or  correct  the 
physical  defects  in  the  clinic ;  the  success  of  the  treatment 
will  often  depend  on  the  subsequent  physiological  and 
mental  habits  of  the  child.  The  effects  of  the  removal  of 
adenoids  and  enlarged  tonsils  are  often  rendered  nugatory 
because  proper  breathing  exercises  are  not  subsequently 
followed.  Since  the  schools  (through  their  teachers, 
nurses  and  medical  inspectors)  are  in  a  position  to  follow 
up  and  properly  supervise  the  child  after  treatment,  it 
seems  desirable  to  treat  all  the  minor  ailments  and  defects 
in  a  school  dispensary.  The  time  must  come  when  physical 
reclamation  work  will  be  recognized  as  one  of  the  regular, 
fmidamental  duties  of  the  city  and  state  school  systems. 

Incidentally  it  may  be  pointed  out  that  the  qualitative 


12      MENTAL  HEALTH  OF  SCHOOL  CHILD 

standards  of  many  medical  inspectors  must  be  elevated  if 
our  highest  hopes  for  child  betterment  from  this  service 
are  to  be  realized. 

But  a  further  step  must  be  taken  in  order  to  supple- 
ment and  render  effective  in  the  highest  measure  the  results 
of  medical  inspection  and  treatment  and  of  pedagogical 
training.  That  is  the  psyclwlogical  inspection  of  our 
large  army  of  mentally  exceptional  school  children.  We 
do  not  know  the  complete  status  of  the  child  when  we  have 
merely  examined  his  bodily  aspect  by  the  available  instru- 
ments of  precision.  The  child  possesses  a  mental  aspect 
which  needs  to  be  just  as  thoroughly  explored  by  instru- 
ments of  precision.  For  the  mental  examination  the 
instruments  and  the  methods  of  medical  inspection  do  not 
suffice ;  this  work  requires  a  technique  of  its  own.  Thus 
it  is  important  to  know  how  the  child's  motor  functions 
vary,  in  respect  to  strength,  steadiness,  power  to  coordi- 
nate and  speed  of  reaction ;  how  his  powers  of  memory, 
association,  imitation,  adaptation,  observation,  attention, 
judgment,  reasoning,  speech,  ability  to  withstand  fatigue, 
pressure  and  pain  thresholds,  perception  of  color  (color 
blindness)  and  intellectual  level  vary,  etc.  Until  such 
facts  as  these  are  known,  we  can  have  nothing  but  the 
most  general  knowledge  of  the  cliild's  mental  constitution. 
Only  by  tests  of  this  nature  will  it  be  possible  to  reveal 
striking  departures  in  fundamental  mental  make-up ;  only 
thus  will  it  be  possible  to  determine  whether  the  mental 
variations  in  a  given  child  are  of  the  nature  of  aberrations 
or  abnormalities.  And  only  when  this  knowledge  has  been 
obtained  will  it  be  possible  to  make  the  training  of  a 
mentally  defective  or  unusual  child  scientifically  accurate, 
because  the  training  of  exceptional  children  must  be 
adapted  to  the  exigencies  of  each  case ;  it  must  be  made  to 


INSPECTION  OF  SCHOOL  CHILDREN        13 

fit  the  special  needs  of  every  special  child.  In  the  absence 
of  thorough  knowledge  of  the  child's  mental  peculiarities 
instruction  must  remain  a  hit-and-miss  process.  So  far 
as  the  teacher  is  concerned,  medical  inspection  and  treat- 
ment yield  knowledge  of  minor  importance  for  her  guid- 
ance. Medical  treatment  is,  of  course,  primarily  of  value 
to  the  individual  pupil.  It  is  a  means  of  freeing  him  from 
his  physical  impediments,  so  that  heredity  may  come  to 
her  own.  And  it  is,  indeed,  a  God-send  to  the  schools  in  the 
case  of  the  child  whose  abnormal  physical  functions  impede 
educational  progress.  Nevertheless,  the  psychological 
examination  yields  knowledge  more  directly  valuable  for 
the  teacher's  guidance,  because  her  work  is  chiefly  with  the 
child's  psychical  functions.  In  the  absence  of  any  exact 
knowledge  of  the  peculiarities  of  the  pupil's  mind  her  work 
must  blunder  along  with  a  mixture  of  happy  hits  and 
unfortunate  misses.  It  is  not  sufficient  that  the  teacher 
adapt  method  to  subject-matter;  she  must  also  adapt 
method  to  the  mind  which  is  to  assimilate  the  subject- 
matter — the  latter  being  the  more  important  in  the  case 
of  the  atypical  child. 

That  the  public  is  rapidly  becoming  awake  to  the  neces- 
sity of  segregating  the  atypical  or  special  child  is  becom- 
ing increasingly  evident.  This  need  has  been  long  recog- 
nized by  the  state  so  far  as  the  idiots,  imbeciles  and  low- 
grade  morons  are  concerned.  More  recently  this  need  has 
been  recognized  by  about  350  cities  which  have  established 
as  an  integral  part  of  the  school  system  so-called  ungraded 
and  special  classes  for  the  retarded,  the  seriously  back- 
ward— for  pupils  whose  mental  caHber  is  superior  to  the 
feeble-minded  but  considerably  inferior  to  the  normal 
child — and  for  the  feeble-minded.  It  is  absolutely  neces- 
sary that  we  segregate  the  subnormals  in  the  public  schools 


14      MENTAL  HEALTH  OF  SCHOOL  CHILD 

for  at  least  two  reasons:  first,  they  constitute  an  intoler- 
able drag  upon  the  regular  classrooms,  impeding  their 
progress  and  consuming  more  than  their  just  share  of 
the  teacher's  time;  and,  second,  by  grouping  subnormals 
together  in  small  classes  they  may  be  given  individual 
attention  by  the  teacher,  and,  what  is  more  important,  be 
provided  with  a  type  of  school  work  which  fits  their  needs 
and  which  will  maximally  equip  them  for  the  socio-indus- 
trial  responsibilities  which  they  are  able  to  assume. 

Unfortunately  the  method  of  classifying  and  segre- 
gating subnormal  children  is  in  most  cities  in  many 
respects  pitiably  inadequate.  These  children  have  almost 
invariably  been  segregated  simply  upon  the  classroom 
teacher's,  principal's,  superintendent's  or  medical  inspec- 
tor's recommendation,  because  they  have  been  unable  to 
furnish  the  required  classroom  output.  They  have  not 
been  subjected  to  a  prior  thorough  scientific  psycho- 
educational  examination,  except  at  the  hands  of  amateur 
psycho-clinicists.  The  special  teacher  usually  gets  the 
laggards  without  adequate  diagnosis,  or  with  mistaken 
diagnosis.  Without  having  any  precise  or  adequate 
knowledge  of  their  mental  and  educational  abnormalities, 
she  is  expected  to  give  them  skilled  differential  peda- 
gogical treatment.  As  a  matter  of  fact,  many  special  class 
teachers  are  simply  shooting  in  the  dark,  and  many 
administrators  seem  to  feel  that  provided  the  teacher 
'keeps  eternally  at'  the  laggards  she  is  doing  all  that  can 
be  reasonably  demanded  of  her. 

In  the  light  of  the  above  facts,  does  it  not  seem  the  part 
of  public  wisdom  and  economy  to  establish  in  every  school 
system  a  psycho-educational  clinic  for  the  educational  and 
the  psychological  examination  of  all  types  of  educationally 
misfit  children  ?    Should  there  not  be  connected  with  every 


INSPECTION  OF  SCHOOL  CHILDREN        15 

school  system  of  any  considerable  size  an  expert  clinical 
psychologist  to  supervise  the  examination  and  training  of 
educationally  exceptional  children? 

So  far  as  relates  to  the  medical  inspection  of  all  school 
children,  departments  have  been  organized  in  the  schools  of 
all  the  large  cities  of  the  country.  But  it  must  be  con- 
ceded that  so  far  as  organized  psychological  inspection  is 
concerned  we  have  made  only  a  beginning,  even  in  the 
large  city  systems.  True,  a  number  of  schools  have  done 
pioneer  work  of  great  intrinsic  value  in  this  line  of 
endeavor,  notably  the  Chicago  pubhc  schools,  which  for 
years  have  conducted  as  an  integral  part  of  the  school 
system  a  department  of  Child  Study  and  Pedagogic  Inves- 
tigation. Many  other  city  school  systems  are  beginning 
to  establish  psychological  clinics  (see  Chapter  XVIII), 
but  the  work  is  usually  conducted  by  medical  inspectors  or 
teachers  who  are  profoundly  ignorant  of  the  detailed 
psychology  and  pedagogy  of  mental  and  educational  ab- 
normalities. This  is,  I  feel,  but  a  temporary  stage  in  the 
work;  eventually  the  schools  will  demand  the  services 
of  competent  experts  for  this  work.  The  fact  that 
many  institutions  for  the  feeble-minded  have  established 
psychological  clinics  and  are  demonstrating  their  value 
for  the  proper  educational  classification  and  treatment 
of  their  inmates,  and  the  fact  that  many  universities  have 
established  psychological  clinics  not  only  for  the  examina- 
tion of  cases  but  for  the  training  of  competent  examiners, 
augur  well  for  the  rapid  development  of  the  public  school 
clinic.  (The  Russell  Sage  Foundation  has  rendered  some 
aid  to  the  'cause'  by  the  compilation  of  retardation  and 
elimination  statistics,  but  it  has  done  only  a  modicum  of 
what,  with  its  vast  resources,  it  could  be  reasonably 
expected  to  do  in  the  direction  of  establishing  the  normal 


16      MENTAL  HEALTH  OF  SCHOOL  CHILD 

mental  norms  which  are  so  much  needed  for  the  more  exact 
psychological  diagnosis  of  mentally  unusual  children.) 
The  school  public  will  soon  come  to  reahze  that  their  duty 
toward  the  educationally  exceptional  child  has  not  been 
discharged  until,  in  addition  to  providing  him  with  the 
advantages  of  medical  inspection  and  treatment,  they  also 
supply  the  adequate  machinery  for  determining  his 
psychological  and  educational  abnormalities. 

The  first  line  of  psycho-cHnical  work  undertaken  by  the 
schools  should  be  the  expert  examination  of  the  so-called 
laggards  or  dullards  (more  properly  the  feeble-minded 
and  seriously  backward).  The  laggard  is  the  one  who 
creates  the  grave  administrative  problems  of  the  schools ; 
he  it  is  who  binds  a  millstone  about  the  neck  of  the  educa- 
tional organism,  who  impedes  the  progress  of  the  regular 
classes,  who  causes  expensive  repetition  or  early  eHmina- 
tion ;  who  has  bottled  up  within  his  self  the  concentrated 
mischief  of  the  school  community ;  who  gives  little  or  no 
returns  for  the  excessive  demands  which  he  makes  upon  the 
teacher's  time  and  energy.  The  normal  child,  thanks  to 
his  hereditary  endowment,  is  fairly  well  able  to  fight  out 
his  own  salvation.  In  him  nature  will  assert  herself  even  in 
the  face  of  untoward  environing  circumstances.  I  would 
not,  of  course,  have  this  type  of  child  neglected ;  he  ought 
to  be  offered  every  facility  to  work  at  his  maximal  poten- 
tial ;  the  normal  and  bright  pupils  are  the  children  of 
greatest  promise  to  the  state.  But  as  long  as  retarded 
children  are  permitted  to  encumber  the  progress  of  the 
regular  grades  we  cannot  do  our  duty  by  the  gifted  pupils. 
Our  first  duty,  then,  is  the  removal  of  the  laggards  from 
the  regular  grades:  this  is  the  'Macedonian  cry.'  Any 
plan  of  psycho-educational  inspection  must  first  aim  to 
reach  the  retarded  children. 


INSPECTION  OF  SCHOOL  CHILDREN        IT 

As  a  matter  of  fixed  school  policy  every  child  who  has 
spent  not  more  than  two  years  in  the  same  grade  {i.e.,  who 
is  retarded  not  more  than  one  year)  should  be  given  a 
physical  examination  by  a  medical  expert  for  the  detection 
and  treatment  of  defects  of  the  eyes,  ears,  nose,  throat, 
teeth,  glandular  system,  lungs,  heart,  nutrition,  nervous 
disorders,  etc, ;  and  a  psychological  examination  by  a 
competent  consulting  psychologist  for  the  detection  of 
intellectual  retardation  and  anomahes  of  sensation,  move- 
ment, memory,  imagination,  association,  attention,  imita- 
tion, color  perception,  speech,  number  sense,  fatigue  and 
for  the  determination  of  indices  of  stature,  weight,  vitality 
and  dynamometry,  etc.  The  determination  may  very  well, 
in  each  case,  be  restricted  to  the  most  essential  tests. 
These  examinations,  together  with  the  previous  academic 
record  and  family  history  of  the  child,  would  determine 
whether  he  should  remain  in  one  of  the  regular  classes  or 
whether  he  should  be  assigned  to  one  of  the  special  classes 
for  backward  or  feeble-minded  children.  It  would  also 
determine  details  of  pedagogic  treatment.  A  retarded 
child  found  mentally  defective  through  this  winnowing  pro- 
cess should  be  compelled,  by  school  enactment,  to  enter  the 
special  class  where  he  can  be  educated  with  a  small  number 
of  his  Hkes.  The  first  attention  which  some  of  these  chil- 
dren should  receive  should  be  medical :  any  physical  handi- 
caps which  impede  the  efl^cient  activity  of  the  mind  should 
be  removed  before  the  child  is  compelled  to  undergo  the 
educative  processes  of  the  schoolroom.  Whether  such 
treatment  could  by  due  process  of  law  be  made  compulsory 
would  be  a  matter  for  judicial  decision.  The  child  is  com- 
pelled under  the  law  to  attend  school;  is  it  not  his  right, 
under  a  parity  of  reasoning,  to  demand  that  the  state  put 
him  in  such  condition  that  he  can  assimilate  those  con- 


18      MENTAL  HEALTH  OF  SCHOOL  CHILD 

tents  demanded  of  him  by  a  compulsory  attendance  law? 
Certain  it  is  that  mere  recommendation  is  not  sufficient: 
there  is  a  large  gap  between  advising  a  parent  to  provide 
proper  medical  treatment  for  his  child,  and  actually 
getting  the  child  treated  in  accordance  with  the  recom- 
mendation. Until  the  public  is  sufficiently  educated  on  the 
question,  some  form  of  pressure  must  be  applied.  Fol- 
lowing this,  however,  each  child  should  be  subjected  to  such 
pedagogical  and  mental  treatment  or  training  as  the  prior 
psychological  and  medical  examinations  have  indicated  as 
specially  pertinent  to  his  case.  When  a  child  is  trans- 
ferred to  a  'special'  school  a  brief  transcript  of  the  psycho- 
logical examination,  together  with  the  examiner's  recom- 
mendation, should  accompany  him.  With  this  record  in 
her  possession  the  classroom  teacher  will  be  able  to  proceed 
with  eyes  open  to  a  systematic  and  rational  development  of 
those  functions  which  have  become  atrophied  or  remained 
dormant. 

In  order  that  there  be  no  misapprehension  it  should  be 
stated  that  a  large  percentage  of  subnormal  children  are 
purely  educational  and  not  medical  cases.  Their  mental 
improvement  depends  almost  entirely  upon  proper  peda- 
gogical training  and  little,  if  at  all,  upon  medication  or 
surgical  interference. 

Under  the  above  scheme  of  segregation  of  the  feeble- 
minded and  backward  from  the  average  and  bright  pupils, 
the  psychological  clinic  (together  with  the  special  classes) 
would  naturally  become  an  educational  clearing  house. 
Some  pupils  sent  to  the  special  classes  would  eventually  be 
returned  to  the  regular  classes ;  others,  on  the  contrary, 
would  be  sent  to  the  feeble-minded  institutions.  Some  of 
those  who  proved  to  be  retarded  because  of  physical  defects 
would  eventually  catch  up  with  their  fellows  after  having 


INSPECTION  OF  SCHOOL  CHILDREN        19 

received  proper  medical  treatment  and  special  mental 
training,  and  could  thus  be  returned  to  the  regular  class- 
rooms. Likewise,  many  pupils  merely  standing  in  need  of 
specific,  corrective  pedagogic  treatment  would  be  con- 
siderably improved,  and  often  could  be  restored  to  their 
regular  grades.  On  the  other  hand,  those  who  failed  to 
make  any  appreciable  progress  would  thereby  indicate 
that  their  trouble  was  more  fundamental,  a  condition  of 
general  neural  and  mental  arrest.  Such  incurably  weak 
pupils  should,  after  due  training,  be  relegated  to  institu- 
tions for  the  feeble-minded  or  institutions  of  a  similar 
nature.  Their  defects  are  an  irremediable  condition  and 
not  a  disease  or  a  specific  defect  amenable  to  curative 
treatment.  Even  moronic  defectives  can  be  trained  to 
become  self-supporting  under  direction  only,  and  should  be 
permanently  isolated  in  custodial  institutions  where  the 
conditions  render  it  possible  for  them  to  support  them- 
selves, instead  of  being  turned  adrift  upon  society,  to 
become  the  victims  of  its  vicious  members  and  designing 
rapscallions,  or  to  become  fresh  recruits  to  its  armies  of 
vagabonds,  miscreants,  social  delinquents  and  criminals. 

This  rational  method  of  selecting,  treating  and  educat- 
ing the  mentally  defective  or  subnormal  pupils  must 
appeal,  not  only  to  the  generous  instincts  aroused  in  any 
normal  human  soul  by  the  contemplation  of  the  sad  story  of 
these  unfortunates,  but  also  to  our  sense  of  business  econ- 
omy and  instinct  of  self-preservation.  Society  must  do 
this  work  for  its  own  protection.  Preventive  medicine, 
preventive  philanthropy,  preventive  didactics,  mental 
hygiene,  are  better  and  cheaper  in  the  end  than  alms- 
houses, jails,  prisons  and  an  army  of  penal  officers.  The 
plan  here  advocated  would  yield  results  out  of  all  propor- 
tion to  the  money  expended. 


20      MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  psychological  inspection  in  the  city  schools,  to 
which  I  have  referred,  might  be  made  a  function  of  the 
department  of  psychology  of  training  schools  for  teachers 
supported  by  municipalities,^  until  the  work  has  been 
thoroughly  organized  and  developed  in  a  separate  division 
of  the  school  systems.  The  director  of  the  psychological 
laboratory  (but  only  provided  he  possesses  adequate  clini- 
cal training  and  experience^  might  serve  as  the  director 
of  the  psychological  clinic.  Three-fourths  of  his  time 
might  properly  be  devoted  to  the  work  of  routine  inspec- 
tion, and  one-fourth  to  the  work  of  regular  classroom 
instruction  in  the  school  of  education.  Tliis  plan  would 
render  it  possible  to  inaugurate  the  work  with  a  compara- 
tively small  outlay  of  money,  as  the  laboratory  apparatus 
could  be  used  for  a  twofold  purpose:  instruction  in  the 
normal  school  and  pupil  inspection.  This  plan  would  tend 
to  vitalize  the  instruction  in  psychology  by  bringing  the 
instructor  into  first-hand  contact  with  important  concrete 
situations.  It  would  give  a  new  significance  and  content  to 
'child  study,'  and  afford  enriched  opportunities  for  the 
students  in  the  'observation  courses.'  What  'apphed' 
science  signifies  in  contrast  with  'pure'  science,  'individual' 
psychology  would  come  to  mean  in  contrast  with  'general' 
psychology.  Individual  psychology  would  assume  a  clini- 
cal significance,  and  become  of  service  for  mental  diagnosis 
and  educational  guidance. 

Psychology  is  destined  to  have  not  only  a  pedagogic 
but  a  clinical  value  for  education.  Eventually  we  shall 
have  an  independent  science  of  clinical  psychology  or 
clinical  education,  instruction  in  which  wall  be  afforded  in 
all  of  the  large  progressive  normal  schools  and  colleges 

3  Schools  of  education  under  private  or  state  control  could  make 
similar  arrangements  with  public  school  systems. 


INSPECTION  OF  SCHOOL  CHILDREN        21 

of  education.  And  we  shall  also  have  psychological  or 
psycho-educational  clinics  in  the  large  school  systems, 
manned  by  psychological  and  educational  experts,  for  the 
purpose  of  classifying  the  educational  misfits. 


CHAPTER  II 

THE   NEW  CLINICAL  PSYCHOLOGY  AND   THE 
PSYCHO-CLINICIST^ 

Scientific  psychology  is  essentially  a  modern  creation. 
It  is  only  about  a  half  century  since  the  scientific  methods 
of  induction  and  experimentation  were  systematically 
applied  to  the  study  of  mental  phenomena.  Yet  we  pos- 
sess, after  this  brief  half  century  of  labor,  not  only  a 
fairly  complete  body  of  reliable  theoretical  psychology, 
but  the  promising  beginnings  of  a  number  of  applied 
psychologies.  The  methods  and  results  of  the  new 
psychology  have  been  applied,  with  gratifying  results, 
during  the  last  decade  or  two  to  the  study  of  problems  in 
history,  literature,  art,  anthropology,  sociology,  eco- 
nomics, business,  hygiene,  medicine,  insanity,  feeble- 
mindedness, criminology,  law,  education  and  paidology. 
Its  services  thus  far  have  been  most  valuable,  perhaps, 
to  education  and  medicine,  and  the  outlook  in  these  fields 
justifies  the  expectation  that  we  shall  soon  have  to  christen 
various  new  independent  sciences,  namely,  the  sciences  of 
experimental  pedagogy,  experimental  psycho-pathology 
(with  psy cho- therapy )  and  clinical  psychology  (or  better 
still,  perhaps,  psycho-educational  pathology). 

In  the  present  chapter  we  shall  discuss  one  of  the  most 
promising  of  the  recent  applications  of  psychology, 
namely,  the  new  psycho-clinical  movement,  which  has  won 

1  Reprinted,  with  extensive  alterations,  from  The  Journal  of 
Educational  Psychology,  1911,  pp.  121-132,  and  191-210. 


NEW  CLINICAL  PSYCHOLOGY  23 

recognition,  within  a  decade,  in  a  number  of  universities, 
normal  and  medical  schools,  hospitals  for  the  insane,  insti- 
tutions for  the  feeble-minded  and  epileptic,  reformatories 
and  correctional  institutions,  immigration  stations,  juve- 
nile courts  and  public  schools.  The  discussion  will  per- 
tain more  particularly  to  the  educational  aspects  of  the 
movement — the  psycho-clinical  and  psycho-educational 
examination  of  school  children. 

1.  The  psychological  clinic  in  the  higher  institutions 
of  learning:  the  universities,  colleges,  normal  schools  and 
medical  schools.  Dr.  Lightner  Witmer,  to  whom  we  owe 
the  name  clinical  psychology,^  is  the  pioneer  psycho- 
clinician  in  connection  with  the  university  laboratories  of 
psychology.  His  interest  in  the  phenomena  of  mental  re- 
tardation began  in  1889,  when  his  attention  was  drawn  to 
a  boy  who  suffered  from  retardation  through  speech  defect ; 
but  it  was  not  until  March,  1896,  that  he  opened  the  Psy- 
chological Clinic  of  the  University  of  Pennsylvania  and 
received  his  first  case,  a  chronic  bad  speller  (34,  35). 
Since  that  time  Witmer's  work  has  continued  uninterrupt- 
edly and  has  grown  apace,  so  that  three  hours  daily  are 
now  (since  1909)  devoted  to  the  examination  of  children. 
These  children  come  from  homes,  institutions,  public  and 
private  schools  and  juvenile  courts  of  Philadelphia  and  the 

2  Clinical  psychology  is  not  synonymous  with  medical  psychology 
or  psychopathology  or  psychiatry  (see  Chapters  III,  V  and  X). 
Clinical  means  literally  bedside,  and  was  applied  originally  to  the 
first-hand  (bedside)  method  of  studying  the  individual  patient.  In 
psychology  it  designates  the  method  of  determining  the  mental  status 
or  peculiarities  of  an  individual  by  a  many-sided  process  of  first- 
hand observation,  testing  and  experiment.  The  clinical  method  may 
be  used  in  the  study  of  normal  as  well  as  of  abnormal  mentality. 
I  suggest  the  use  of  the  words  psycho-clinical,  psycho-educational 
and  medico-clinical  to  designate,  respectively,  psychological,  educa- 
tional and  medical  examinations  by  the  clinical  method. 


24      MENTAL  HEALTH  OF  SCHOOL  CHILD 

surrounding  territory.  Witmer's  work  embraces  a  physi- 
cal, psychological  and  sociological  examination,  in  which  a 
number  of  experts  cooperate — a  psychologist,  neurologist, 
dentist,  oculist,  nose  and  throat  speciaHst  and  social 
worker.  The  social  worker  makes  a  first-hand  examination 
of  the  child's  home  conditions,  renders  aid  in  the  mitigation 
of  bad  environmental  influences,  and  by  means  of  'follow- 
up  work'  sees  that  the  treatment  prescribed  for  the  child 
is  carried  out.  The  cHnic  does  not  limit  itself  to  the 
problem  of  diagnosis ;  an  orthogenic  home  school,  or 
'hospital  school,'  was  established  in  July,  1907,  for  the 
medical  and  pedagogical  treatment  of  pay  and  free  cases. 
This  is  a  combined  home,  hospital  and  training  school, 
where  the  child  is  provided  with  proper  food,  baths,  out- 
door exercise,  sleep,  medical  attention,  discipline,  motor 
training  and  intellectual  drill  in  the  rudiments  of  the 
school  fundamentals.  This  school  also  serves  as  a  school 
of  observation  and  a  clinic  for  further  diagnosis.  Records 
of  the  child's  hereditary,  family  and  personal  history 
(accidents,  diseases,  educational  record,  present  mental 
and  physical  status)  are  preserved  for  reference.  Courses 
in  clinical  psychology  are  offered  to  teachers  during  the 
regular  and  summer  sessions,  while  classes  for  mentally 
exceptional  children  are  conducted  during  the  summer  for 
purposes  of  training  and  observation.  Witmer  also  edits 
The  Psychological  Clinic,  now  in  its  eighth  volume,  which 
is  devoted  to  the  study  of  the  psychology,  hygiene  and 
education  of  children  who  are  mentally  and  morally 
deviating. 

Within  the  last  few  years  the  psychological  clinics  have 
multiplied  very  rapidly.  In  order  to  obtain  more  accurate 
knowledge  concerning  the  psycho-clinical  work  attempted, 
and  the  courses  offered  in  the  psychology  and  pedagogy  of 


NEW  CLINICAL  PSYCHOLOGY  25 

mentally  exceptional  children  in  the  colleges,  universities, 
medical  and  normal  schools  in  the  United  States,  a  ques- 
tionnaire was  sent  out  in  January  and  again  in  September 
and  October,  1913,  to  the  professors  of  psychology  or 
education  in  all  the  universities  and  in  all  the  larger  col- 
leges, to  the  principals  of  all  the  state  and  city  normal 
schools  and  to  the  deans  of  all  the  medical  schools  of  the 
country.  My  thanks  are  due  to  the  many  respondents 
whose  repHes  made  this  study  possible.  The  following 
were  the  questions  asked : 

1.  Do  you  conduct  a  psychological  clinic  for  the  actual 
examination  of  all  mentally  exceptional  cases  referred  to  you.'' 
(Date  of  organization,  name  and  preparation^  of  clinician,  and 
equipment.) 

2.  What  per  cent  of  the  clinician's  time  is  given  to  the 
actual  clinical  examination  of  cases  ?  What  per  cent  of  his 
time  is  given  to  teaching?  To  teaching  branches  other  than 
clinical  psychology  and  the  study,  care  and  education  of 
exceptional  children? 

3.  Do  you  conduct  a  training  clinic  for  training  students 
in  the  methods  of  psycho-clinical  and  anthropometric  exami- 
nation and  diagnosis  ? 

4.  What  didactic  courses  (lectures  or  recitations)  are 
offered  in  clinical  psychology  and  the  psychology  and  peda- 
gogy of  exceptional  children? 

5.  Do  you  conduct  training  classes  for  exceptional  chil- 
dren? If  so,  are  they  open  to  students  for  observation  and 
cadet  teaching? 

6.  What  plans  are  being  made  for  the  organization  or 
extension  of  this  type  of  work? 

Replies  were  received  from  sixty-six  colleges  and  uni- 
versities, thirty-three  state  and  city  normal  schools  and 

3  The  academic  data  are  given  in  the  subsequent  pages  only  for 
specialists  who  are  actually  conducting  psychological  clinics. 


26      MENTAL  HEALTH  OF  SCHOOL  CHILD 

twenty-five  medical  schools.  The  replies  are  topically 
summarized  under  the  above  captions  in  the  following 
pages.  When  the  questions  are  left  blank  it  is  to  be 
inferred  that  the  answers  are  negative.  The  dates  given 
refer  to  the  time  when  the  clinical  work  or  courses  were 
first  organized.  'Hours'  means  the  number  of  hours  per 
week. 

Several  institutions  which  were  known  to  offer  the  type 
of  work  contemplated  in  the  questionnaire  failed  to  make 
reply,  although  two  or  three  inquiries  were  addressed  to 
them.  In  some  of  these  cases  data  have  been  gathered 
from  the  catalogues  and  included  in  this  tabulation. 

The  repHes  are  tabulated  separately  for  the  universities 
and  colleges,  the  normal  schools  and  the  medical  schools, 
in  accordance  with  the  following  grouping: 

Group  I  comprises  institutions  which  have  established 
bona  fide  psychological  or  psycho-educational  clinics ;  that 
is,  laboratories  whose  regular,  primary  and  essential 
function  is  the  psychological  or  educational  examination 
of  individual  cases,  for  purposes  of  diagnosis  and  advice. 

Group  II  comprises  institutions  which  either  have  given 
in  the  immediate  past  or  which  do  at  the  present  time 
give  a  slight  amount  of  attention  to  the  psychological 
testing  of  children  with  a  view  to  arriving  at  individual 
mental  diagnosis.  These  institutions  can  scarcely  be  said 
to  conduct  psychological  clinics,  although  more  or  less 
psycho-clinical  work  may  be  attempted  in  the  laboratories 
of  psychology,  education  or  psycho-  or  neuro-pathology 
(in  the  case  of  medical  schools). 

Group  III  comprises  institutions  which  do  absolutely 
no  clinical  work  in  psychology  or  education  (or  at  most 
a  very  negligible   amount  of  it),  but  which  either  give 


NEW  CLINICAL  PSYCHOLOGY  27 

some  attention  to  the  study  of  mentally  exceptional 
children  or  which  are  ready  to  develop  certain  lines  of 
this  work. 

Universities  and  Colleges 
Group  I 

University  of  Pennsylvania 
(From  the  catalogue,  1912-1913) 

1.  'Psychological  Clinic'  organized  in  March,  1896,  in 
the  department  of  psychology.  Director,  Lightner  Witmer, 
Professor  of  Psychology  (Ph.D.  in  psychology),  assisted  by 
a  staff  of  psychologists,  physicians  and  social  workers. 

3.  Yes. 

4.  (1)   'Growth  and  Retardation'   (Witmer). 

(2)  'Tests  and  Measurements,'  3  hours  one  or  two  terms. 

(3)  'Social  Research  in  Clinical  Psychology,'  4  hours  one 
term. 

(4)  'The  Exceptional  Child,'  1  hour  one  term. 

(5)  'The  Training  and  Treatment  of  Exceptional  Chil- 
dren,' 1  hour  one  term. 

(6)  'Clinical  Psychology,'  1  hour  one  or  two  terms. 

(7)  'Mental  Defects,'  1^  hours  one  term. 

(8)  'Orthogenics,'  1^  hours  one  term. 

5.  Yes. 

Didactic  and  clinical  courses  and  an  observation  class  are 
conducted  during  the  summer  term. 

University  of  Washington 

1.  Clinic  in  operation  in  the  department  of  psychology 
since  the  fall  of  1909;  conducted  since  1911  by  the  Bailey 
and  Babette  Gatzert  Foundation  for  Child  Welfare.  A  fund 
of  $30,000  was  given  to  the  University  in  December,  1910, 
for  the  maintenance   of  a   Bureau   of   Child  Welfare  in  the 


28      MENTAL  HEALTH  OF  SCHOOL  CHILD 

School  of  Education,  whose  purpose  is  to  provide  expert 
diagnosis  of  mentally  and  physically  exceptional  children, 
to  cooperate  with  local  authorities  throughout  the  state  in  the 
establishment  of  psychological  laboratories  and  special  classes, 
to  furnish  teachers  and  experts  for  the  work,  and  to  collect 
and  publish  data.  Director,  Stevenson  Smith,  Assistant 
Professor  of  Orthogenics  (Ph.D.  in  psychology;  additional 
work  in  the  Psychological  Clinic  of  the  University  of  Penn- 
sylvania and  in  the  Vanderbilt  Clinic,  New  York  City)  ;  one 
assistant,  two  graduate  student  assistants  and  four  medical 
assistants.  The  Director  holds  the  appointment  of  psycholo- 
gist to  the  Public  Schools  and  Juvenile  Court,  and  does  a 
certain  amount  of  field  work  throughout  the  state.  Rooms 
are  provided  in  the  university  psychological  laboratory. 

2.  Seven-eighths  of  Director's  time  given  to  clinical  exami- 
nation and  instruction  of  children;  rest  of  time  given  to  teach- 
ing. No  teaching  of  subjects  other  than  those  pertaining  to 
the  clinical  work. 

3.  Instruction  given  to  graduate  and  undergraduate  stu- 
dents in  psychological,  anthropological  and  medical  methods 
of  diagnosis,  in  courses  given  in  4  below. 

4.  (1)  'Psychology  and  Education  of  Exceptional  Chil- 
dren,' in  School  of  Education,  4  hours  during  one  semester 
(Smith). 

(2)  'Laboratory  Course  in  Experimental  Child  Study  and 
Clinical  Psychology,'  in  department  of  psychology,  8  hours 
(4  credits)  for  one  semester. 

(3)  'A  Graduate  Course  in  the  Education  of  Exceptional 
Children'  (practical  work  in  the  Psychological  Clinic  and 
special  classes  in  the  public  schools),  in  the  School  of 
Education,  4  credits  (Smith). 

(4)  'A  Practical  Graduate  Course  in  Clinical  Methods,'  in 
the  Department  of  Psychology,  4  credits. 

All  of  the  above  given  since  September,  1911. 

5.  Classes    are    conducted   at    the   university    for    feeble- 


NEW  CLINICAL  PSYCHOLOGY  29 

minded,    backward    and    speech-defective    cases.       Open    to 
student  observation.     Partly  in  charge  of  graduate  teachers. 

6.     Plan  to  increase  didactic  courses  at  the  university. 

The  courses  are  also  offered  during  the  summer  term. 

University  of  Minnesota 

1.  'Free  Clinic  in  Mental  Development/  organized  in  the 
year  1909-1910,  in  the  department  of  psychology.  Director, 
J.  B.  Miner,  Professor  of  Psychology  (Ph.D.  in  psychology), 
assisted  by  Herbert  Woodrow,  Instructor  in  Psychology 
(Ph.D.  in  psychology) ;  by  Fred  Kuhlmann,  Director  of 
Psychological  Research,  Minnesota  School  for  Feeble-Minded 
and  Colony  for  Epileptics  (Ph.D.  in  psychology  and  educa- 
tion) ;  and  by  J.  P.  Sedgwick,  M.D.  Full  laboratory  equip- 
ment in  special  room  at  University.  Examinations  are  also 
made  in  reserved  room  in  City  and  County  Court  House  and  in 
public  school  buildings. 

2.  One  or  two  days  a  week,  including  work  in  Juvenile 
Court ;  work,  which  is  divided  among  several  men,  is  equivalent 
to  three-fourths  of  the  time  of  one  man. 

3.  Students  attend  psychological  clinic;  they  have  their 
attention  directed  to  the  simpler  matters  in  medical  diagnosis ; 
and  are  privileged  to  visit  pediatric  clinics  and  the  State  School 
for  the  Feeble-Minded  at  Faribault. 

4.  'Mental  Retardation,'  since  February,  1910,  3  hours 
for  one  semester  (Woodrow) ;  given  to  a  separate  division 
during  the  fall  of  1912  by  Kuhlmann.  Also  includes  psycho- 
clinical  examinations,  and  lectures  on  the  application  of  facts 
to  delinquents,  by  Miner,  and  medical  examination  by 
Sedgwick.  Optional  to  students  with  one  year's  work  in 
psychology. 

5.  Graduate  students  sometimes  work  with  individual  chil- 
dren. A  class  was  at  one  time  conducted  for  the  correction  of 
stuttering. 

Courses  are  offered  by  various  specialists  in  the  summer 
school. 


30      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Johns  Hopkins  University  and  Phipps  Psychiatric  Clinic 

1.  Psychological  clinic  established  in  February,  1911. 
Director,  E.  B.  Huey,*  Lecturer  on  Mental  Development  in  the 
Johns  Hopkins  University,  and  Assistant  in  Psychiatry  in  the 
Phipps  Clinic  of  Johns  Hopkins  Hospital  (Ph.D.  in  psychol- 
ogy and  education;  special  work  in  institutions  for  the  feeble- 
minded and  in  clinics  here  and  abroad)  ;  under  the  general 
direction  of  Dr.  Adolf  Meyer.  Several  rooms  available  in  the 
new  Phipps  Clinic,  but  no  apparatus  secured  as  yet. 

2.  Six  hours  per  week.  About  one-half  of  the  Director's 
time  is  given  to  examination  and  treatment. 

3.  No  training  clinic,  but  students  in  medicine  and  psy- 
chology assist  in  the  testing. 

4.  (1)  'Feeble-minded  and  Backward  Children,'  January, 
1911,  1  hour  for  one  term  (Huey). 

(2)    'Clinical  Psychology,'  in  the  Medical  School,  consisting 
of  lectures  and  tests,  1  hour  for  one  term  (Huey). 
No  courses  in  other  than  clinical  work. 

5.  Experimental  class  for  defective  children  was  to  be 
established  in  the  Baltimore  schools,  enrollment  limited  to  15, 
none  under  the  mental  age  of  six,  under  Huey's  direction. 

University  of  Kansas 

1.  Clinic  established  in  1911,  in  department  of  education. 
Director,  A.  W.  Trettien,  Assistant  Professor  of  Education 
(Ph.D.  in  psychology  and  education;  additional  work  in  hos- 
pitals in  Worcester).  Two  rooms  available;  use  of  equipment 
in  Medical  School.  Visits  to  homes.  Have  tested  inmates  in 
Boys'  Industrial  School. 

2.  Two  hours. 

3.  No. 

4.  (1)    'Educational   Pathology,'   since   1910,   2   hours   for 

4  Dr.  Huey  died  December  30,  1913.  No  data  as  to  what  extent  of 
the  work  in  this  clinic  will  now  be  devoted  to  psycho-educational  as 
distinguished  from  psycho-pathological  examinations. 


NEW  CLINICAL  PSYCHOLOGY  31 

18    weeks,    with    clinical    work    (Trettien    and    Prof.    R.    A. 
Schwegler). 

(2)  'School  Hygiene,'  3  hours  for  18  weeks,  covers  certain 
aspects  of  the  work  (Trettien). 

(3)  'Mental  Measurements,'  2  hours  (Schwegler). 

5.  No,  but  have  placed  children  under  instruction  and 
observation. 

6.  Plan  to  enlarge  the  work,  under  the  direction  of  the 
School  of  Education  and  School  of  Medicine. 

Leland  Stanford,  Jr.,  University. 

1.  Clinic  established  in  the  year  1911-1912,  in  the  School 
of  Education.  Director,  Louis  M.  Terman,  Associate  Pro- 
fessor of  Education  (Ph.D.  in  psychology  and  education). 
Work  done  in  the  laboratory  of  the  department  of  education 
and  in  neighboring  schools.  About  $400  worth  of  materials 
for  mental  and  physical  testing. 

2.  One  to  5  hours  per  week.  About  one-half  of  the 
Director's  time. 

3.  No,  but  major  students  in  education  are  afforded  prac- 
tice in  giving  Binet  and  other  tests. 

4.  (1)  'Clinical  Child  Psychology,'  since  1911-1912,  2 
hours  throughout  the  year  (Terman). 

(2)  'Seminary  and  Research  Course  in  the  Psychology  and 
Pedagogy  of  Backward  Children'  (Prof.  Percy  E.  Davidson). 

5.  A  class  was  conducted  from  1910  to  1912;  now  con- 
ducted by  the  town  of  Palo  Alto,  with  the  aid  of  the  university 
clinic;  enrollment,  15. 

University  of  Missouri 

1.  Clinic  organized  in  the  year  1911-1912,  in  the  School 
of  Education,  by  W.  H.  Pyle  (Ph.D.  in  psychology). 

2.  Irregular;  in  fall  about  two  afternoons  per  week  for 
two  or  three  months.  The  chief  duties  consist  in  teaching 
educational  psychology. 


32      MENTAL  HEALTH  OF  SCHOOL  CHILD 

3.  YeSj  in  connection  with  the  clinic  and  a  course  on  'The 
Scientific  Testing  of  Method.' 

4.  'The  Abnormal  Child/  since  fall  of  1911,  1  hour  (Pyle). 
6.      No,  but  plan  to  conduct  classes  eventually. 

6.  Plan  to  train  teachers  of  subnormal  children,  and  to 
develop  this  work  in  the  state. 

University  of  Pittsburgh 

1.  'Dispensary  Psycho-Educational  Clinic,'  established  in 
March,  1912,  in  the  School  of  Education.  Director,  J.  E,  W. 
Wallin,  Director  of  Psychological  Clinic  and  Professor  of 
Clinical  Psychology  and  Mellen  Research  Fellow  on  the  Psy- 
chology of  Smoke  (Ph.  D,  in  psychology,  philosophy  and 
education ;  special  work  in  institutions  for  epileptics,  feeble- 
minded and  insane,  and  in  medical  clinics  and  schools).  Rooms 
in  temporary  quarters  in  the  School  of  Education.  An  initial 
supply  of  about  $350  worth  of  equipment  for  psychological 
and  anthropometric  testing.  Student  assistant  for  record  work 
on  part  time.  Clinical  examinations  conducted  in  cities  in 
Western  Pennsylvania  and  various  other  states. 

2.  Varies  from  10  to  20  hours  per  week.  Somewhat  less 
than  two-thirds  of  Director's  time  devoted  to  clinical  work;  the 
rest  to  teaching.  One  course  temporarily  offered  in  another 
department. 

3.  'Clinic  Practicum,'  since  June,  1912,  optional.  Open  to 
a  restricted  number  of  students  who  desire  a  practical  com- 
mand of  the  technique  of  mental  and  anthropometric  examina- 
tion methods.  Designed  particularly,  though  not  exclusively, 
for  capable  students  who  seek  expert  preparation  for  research 
or  clinical  work. 

4.  (1)  'Clinical  Psychology  and  the  Clinical  Study  of 
Mentally  Exceptional  Children,'  lectures  with  demonstration 
clinics,  since  April,  1912,  2  hours  for  one  term.  Elective,  but 
required  in  the  department  (Wallin). 

(2)    'The  Care  and  Education  of  Feeble-minded  and  Back- 


NEW  CLINICAL  PSYCHOLOGY  33 

ward  Children/  lectures,  with  clinics  and  visits  to  institutions, 
since  April,  1912,  2  hours  for  two  terms.  Elective,  but 
required  in  the  department  (Wallin). 

(3)  'Psycho-educational  Pathology  and  Educational  Thera- 
peutics,' a  detailed  treatment  of  corrective  pedagogics,  since 
September,  1912,  2  hours  throughout  the  year.  Elective,  but 
required  in  the  department  (Wallin). 

(4)  'Social  Investigation,'  field  work^  since  September, 
1913,  2  to  4  hours  throughout  the  year,  elective  but  advised 
(Wallin). 

(5)  'Manu-mental  and  Industrial  Work  for  the  Backward, 
Feeble-minded  and  Insane,'  since  April,  1913,  2  hours  through- 
out the  year  (Prof.  H.  R.  KnifEn  and  Mr.  Leon  Winslow). 

5.  No;  expect  to  utilize  the  special  classes  in  the  public 
schools  for  observation  and  cadet  teaching.  Have  selected 
pupils  for  many  public  school  classes. 

6.  Plan  to  expand  the  scope  of  the  work  in  various  direc- 
tions. 

The  didactic  and  clinical  courses  are  repeated  during  the 
summer  term,  and  classes  of  feeble-minded  and  backward  chil- 
dren are  conducted  for  training,  observation  and  practical 
teaching. 

Yale  University 

1.  'Juvenile  Psycho-clinic,'  established  in  April,  1912,  in 
the  department  of  education;  examinations  conducted  in  dis- 
pensary of  Medical  School.  Director,  Arnold  Gesell,  Assistant 
Professor  of  Education  (Ph.D.  in  psychology  and  education; 
additional  work  in  the  Medical  School). 

2.  Half  of  Director's  time  given  to  teaching  subjects  other 
than  clinical  psychology. 

8.  Offer  a  'Clinical  and  Research  Course  for  Advanced 
Students,'  1  hour;  includes  visits  to  institutions  and  schools. 

4.  (1)  'Backward  and  Defective  Children  in  the  Public 
Schools,'  since  October,  1912,  2  hours  throughout  the  year. 
Elective  graduate  course  (Gesell). 


34      MENTAL  HEALTH  OF  SCHOOL  CHILD 

(2)   'Norms  of  Development/  scheduled  1  hour  for  second 
half  of  second  term. 
5.     No. 

Harvard  University 

1.  Clinic  conducted  in  the  out-patient  department  of  the 
Psychopathic  Hospital,  Boston,  since  September,  1912.  No 
teclinically  trained  clinical  psychologist,  but  consultation  and 
examination  work  is  divided  between  E.  E.  Southard,  M.D., 
Director;  R.  M.  Yerkes,  Ph.D.,  psychologist;  W.  F.  Dearborn, 
Ph.D.,  psycho-educationalist;  Herman  Adler,  M.D.,  chief  of 
staff;  V.  V.  Anderson,  M.D.,  and  F.  D.  Bosworth,  Jr.,  M.D., 
examiners. 

2.  Clinics  conducted  by  different  examiners  every  after- 
noon except  Sunday.  No  data  as  to  what  extent  the  examina- 
tions are  psycho-educational. 

3.  Clinical  training  afforded  in  Psychopathic  Hospital. 

4.  (1)  'Psychology  of  the  Abnormal,'  since  1912,  summer 
session,  39  lectures,  with  clinics  (William  Healy,  M.D.). 

(2)  'Mental  Heredity  and  Eugenics,'  in  department  of 
psychology  (Yerkes). 

(3)  'Educational  Psychology,'  in  department  of  education 
(Dearborn). 

(4)  'Aspects  of  Mental  and  Physical  Development,'  in 
department  of  education  (Dearborn). 

(5)  'Psychopathology,'  in  department  of  psychology,  with 
clinics,  since  1913-1914  (Adler). 

5.  No. 

6.  Plan  to  perfect  clinical  and  educational  organization  in 
the  out-patient  department  of  the  Psychopathic  Hospital. 

Certain  courses  are  offered  during  the  summer  term. 

University  of  Cincinnati 

1.  Clinic  established  September,  1912,  in  department  of 
psychology.     Director,  B.  B.  Breese,  Professor  of  Psychology 


NEW  CLINICAL  PSYCHOLOGY  35 

(Ph.D.  in  psychology),  assisted  by  Mr.  S.  Isaacs.     Use  of  six 
rooms  in  the  Psychological  Laboratory  of  the  University. 

2.  Three  hours  per  week,  or  one-seventh  of  Director's  time. 

3.  Yes. 

4.  'Mental  Measurements/  since  September,  1912,  3  hours 
for  36  weeks  (Breese  and  Isaacs). 

'Psychology  of  Mentally  Defective  Children'  (seminar),  2 
hours. 

5.  No;  cooperate  with  special  classes  in  public  schools. 

Tulane  University 

1.  Clinic  established  in  October,  1912,  in  School  of  Edu- 
cation of  H.  Sophie  Newcomb  Memorial  College  for  Women. 
Director,  John  Madison  Fletcher,  Assistant  Professor  of 
Experimental  and  Clinical  Psychology  (Ph.D.  in  psychology 
and  education)  ;  supported  jointly  by  Tulane  University  and 
the  New  Orleans  Board  of  Education.^  Board  of  Education 
contributes  $1,500  annually.  Clinic  rooms  in  Psychological 
Laboratory  of  School  of  Education.  Assistants  comprise  a 
supervisor  of  social  investigation,  a  recorder  and  secretary, 
student  assistants  and  an  advisory  medical  staff. 

2.  Three-fourths  of  Director's  time  given  to  clinical  exami- 

5  The  joint  arrangement  was  terminated  during  the  summer  of 
1913,  owing  to  the  resignation  of  Dr.  David  Spence  Hill*  from  the 
acting  directorship  of  the  School  of  Education.  Dr.  HiU  is  now 
director  of  the  recently  created  Department  of  Educational  Research 
in  the  New  Orleans  public  schools.  The  department  at  present  has 
a  budget  of  $3,500  and  during  the  present  year  is  undertaking  the 
following  program  of  work:  a  vocational  survey,  the  individual  study 
of  exceptional  children  and  statistical  studies  of  retardation.  A 
brief  lecture  course  is  also  offered  to  the  students  at  the  city  normal 
school.  A  psychological  laboratory  is  being  equipped  in  the 
director's  rooms  in  the  city  hall. 

*  Hill.  Notes  on  the  Problems  of  Extreme  Individual  Differences 
in  Children  of  the  Public  Schools.  Department  of  Educational 
Research,  New  Orleans  Public  Schools,  1913. 


36      MENTAL  HEALTH  OF  SCHOOL  CHILD 

nation  and  teaching  in  the  department;  rest  of  time  given  to 
teaching  experimental  psychology. 

3.  No. 

4.  (1)  'The  Psychology  of  the  Abnormal  Mind/  3  hours 
for  one  term  (Fletcher). 

(2)  'Clinical  Psychology,'  advanced  course  (Fletcher). 

(3)  'The  Psychology  of  Retardation  and  Mental  Defi- 
ciency' (Fletcher). 

6.  No,  but  classes  have  been  organized  in  the  public 
schools. 

University  of  North  Dakota 

1.  Clinic  started  in  September,  1913,  in  the  department  of 
psychology.  Director,  John  W.  Todd  (Ph.D.  in  psychology, 
educational  psychology  and  philosophy).  Modest  equipment. 
Aim  to  examine  both  normal  and  deviating  children. 

2.  Varies;  the  laboratory  is  regularly  open  from  2  to 
4  p.m.,  Mondays,  Wednesdays  and  Thursdays. 

3.  No. 

4.  None. 

5.  No. 

State  University  of  Iowa 

1.  Clinic  established  in  department  of  psychology,  Sep- 
tember, 1913.  Director,  R.  H.  Sylvester  (Ph.D.  in  psychology; 
special  preparation  in  clinical  psychology).  Aim  to  examine 
children  anywhere  in  the  state. 

2.  Indefinite. 

3.  Plan  to  conduct  a  training  clinic. 

4.  (1)  'The  Backward  Child,'  2  hours  throughout  the  year 
(Sylvester). 

(2)  'Orthogenics,'  2  hours  one  semester  (Sylvester). 

(3)  'Tests  and  Measurements,'  2  hours  for  one  semester 
(Sylvester  and  Mabel  Clare  Williams). 

6.  No,  but  expect  to  treat  speech  defectives. 
Courses  are  offered  during  the  summer  term. 


NEW  CLINICAL  PSYCHOLOGY  37 

University  of  Oklahoma 

1.  Clinic  work  conducted  in  conjunction  with  city  schools 
and  the  state  asylum  for  the  insane,  since  the  fall  of  1913,  in 
the  School  of  Education,  by  W.  W.  Phelan,  Director  of  the 
School  of  Education  and  Professor  of  Psychology  and  Educa- 
tion (Ph.D.  in  psychology). 

3.  No. 

4.  Seminar  course,  2  hours,  since  September,  1913 
(Phelan). 

5.  No. 

6.  Plan  to  organize  the  work  in  the  School  of  Education. 

Group  II 

Clark  University 

1.  No  psycho-clinic  at  present,  but  more  or  less  clinical 
work,  supplemented  by  a  course  of  lectures,  has  been  carried 
on  by  various  men  during  the  last  four  years  in  the  department 
of  psychology. 

Cornell  University 

1.  No,  but  occasional  cases  are  referred  to  Educational 
Laboratory  for  examination,  by  G.  M.  Whipple,  Ph.  D.,  Assist- 
ant Professor  of  the  Science  and  Art  of  Education.  The 
laboratory  has  been  examining  by  Binet  scale  and  other  tests 
various  children  in  the  George  Junior  Republic,  with  a  view  of 
determining  advisability  of  requiring  in  future  a  prior  psycho- 
logical examination  of  all  candidates  for  admission. 

3.  No,  except  as  noted  in  4. 

4.  (1)  'Education  of  Exceptional  Children,'  since  1908,  2 
hours  for  one  semester.     Elective  (Whipple). 

(2)  'Conduct  of  Mental  Tests,'  since  1908,  for  graduate 
and  advanced  students,  3  hours  for  one  semester.  Also  given 
in  summer  session  since  1912,  2^  hours  daily,  with  examina- 
tion of  cases  (Whipple). 


38      MENTAL  HEALTH  OF  SCHOOL  CHILD 

School  of  Pedagogy,  New  York  University 

1.  A  psychological  clinic  is  conducted  for  demonstrating 
cases  in  connection  with  the  lecture  course  given  by  Henry  H. 
Goddard,  Director  of  Research,  New  Jersey  Training  School 
(Ph.D.  in  psychology  and  education). 

3.  Yes,  in  the  summer  session. 

4.  'Education  of  Defectives,'  since  October,  1906,  3  hours 
on  alternate  Saturdays  during  the  academic  year.  Also  given 
during  summer  term  (Goddard). 

5.  Six  special  classes  conducted  during  summer  session 
1912,  15  pupils  in  each  class. 

Numerous  courses  are  offered  during  the  summer  term  by 
various  instructors. 

Girard  College 

1.  Boys  in  the  school  and  candidates  for  admission  have 
been  examined  since  September,  1910,  by  Ralph  L.  Johnson, 
A.M.  (University  of  Pennsylvania  and  New  Jersey  Training 
School).     Have  a  laboratory  with  two  rooms. 

2.  Half  of  examiner's  time  given  to  examination  and  half 
to  teaching  morons. 

3.  No. 

4.  No  didactic  courses  given. 

5.  Conduct  classes  for  morons. 

Group  III 

Alfred  University 

4.  Brief  discussions  on  mental  defectives  in  courses  in 
child  study  and  educational  psychology  (Bessie  L.  Gambrell). 

Barnard  College 

4.  Occasional  reference  to  topics  in  courses  in  experimental 
psychology  (L.  H.  Hollingworth) . 


NEW  CLINICAL  PSYCHOLOGY  39 

Bryn  Mawr  College 
1.     No. 

3.  No,  but  students  visit  the  psychological  clinic  of  the 
University  of  Pennsylvania  and  schools  for  deficient  children. 

4.  'The  Psychology  of  Defective  and  Unusual  Children,' 
a  graduate  seminar  throughout  the  year,  first  given  in  1913- 
1914.    Five  months  (J.  H.  Leuba). 

College  of  the  City  of  New  York 

(From  the  catalogue,  1913) 

4.  'Education  of  Backward  and  Defective  Children,'  lec- 
tures, demonstrations  of  tests,  visits  to  classes  (S.  B. 
Heckman). 

Columbia  University,  Teachers  College 

(From    the    catalogue,    1913) 

4.  'The  Psychology  and  Education  of  Exceptional  Chil- 
dren' (Naomi  Norsworthy  and  E.  A.  Thorndike). 

'Normal  Diagnosis  and  Anthropometry,'  with  demonstra- 
tions (W.  H.  McCastline).  Didactic  courses  are  offered 
during  the  summer  session. 

Dartmouth  College 

1.  A  few  of  the  students  of  the  department  of  psychology 
tested  the  pupils  in  the  public  schools  during  the  fall  of  1912 
by  means  of  the  Binet  scale  (W.  B.  Bingham). 

DePauw  University 

4.  'Abnormal  Psychology,'  including  some  clinical  work, 
formerly  given. 

Mount  Holyoke  College 

3.  No,  but  use  is  made  of  Whipple's  Manual  in  course  in 
Experimental  Psychology    (Samuel  P.   Hayes). 

4.  Reference  reading  on  exceptional  children  in  course  in 
Educational  Psychology, 


40      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Northwestern  University 

4.  'Abnormal  Psychology/  since  1909-1910,  3  hours  for 
one  semester,  elective  (R.  H.  Gault).  A  certain  amount  of 
time  devoted  to  mental  tests  in  course  in  Educational  Psychol- 
ogy- 

6.  It  is  possible  that  psycho-clinical  work  will  be  under- 
taken within  a  year  or  two  by  the  public  schools  or  the 
University. 

Ohio  State   University 

4.  'The  Defective  Child/  lectures,  recitations  and  demon- 
strations, one  semester,  3  credit  hours  (T.  H.  Haines). 

Ohio  University,  Athens 

4.  Incidental  reference  to  these  topics  in  courses  in  psy- 
chology (Oscar  Chrisman),  and  'Educational  Psychology' 
(Willis  L.  Gard).  Expect  to  give  a  systematic  course  in  the 
near  future. 

Pennsylvania  State  College 

4.  Occasional  lectures  given  to  students  on  exceptional 
children  (A.  Holmes). 

Princeton  University 

4.  Topics  are  referred  to  incidentally  in  course  in  'Genetic 
Psychology,'  since  February,  1910  (Howard  C.  Warren). 

Rutgers  College 

4.  About  10  hours  in  all  given  to  these  subjects  in  courses 
in  Elementary,  Advanced  and  Educational  Psychology  and 
School  Administration  (W.  T.  Marvin  and  Alexander  Inglis). 

6.      Plans  for  future  development  not  yet  matured. 


NEW  CLINICAL  PSYCHOLOGY  41 

University  of  California 
1.     No. 

4.  During  the  summer  session  of  1913^  the  following 
courses  were  offered: 

'Clinical  Psychology  and  the  Teaching  of  Exceptional  Chil- 
dren/ with  demonstration  clinic  (F.  G.  Bruner,  Ph.D.,  Clinical 
Psychologist  to  the  Board  of  Education,  Chicago). 

'Clinical  Examination  and  Training  of  Subnormal  Children' 
(Mrs.  Vinnie  C.  Hicks). 

5.  'Training  class  for  Subnormal  Children/  open  for 
observation  (Mrs.  Vinnie  C.  Hicks,  Miss  Nellie  Goodhue  and 
Miss  Frances  H.  Ney). 

6.  Plan  to  establish  a  psychological  clinic,  in  affiliation 
with  departments  of  education,  psychology  and  medicine. 

University  of  Chicago,  School  of  Education 

4.  'Psychopathic,  Retarded  and  Mentally  Deficient  Chil- 
dren,' 4  hours  for  twelve  weeks,  given  only  in  1910-1911. 

University  of  Idaho 

4.  Referred  to  incidentally  in  courses  in  Educational  and 
Experimental  Psychology  (P.  H.  Soulen). 

University  of  Illinois 

1.     No  clinic,  but  apparatus  is  available  for  starting  work. 
4.     Three  hours  during  one  semester  devoted  to  these  topics 
in  course  in  Educational  Psychology  (W.  C.  Bagley). 

University  of  Indiana 
(From  the  catalogue  of  the  summer  session,  1913) 

4.  'Orthogenics,'  recitations  and  laboratory  work,  open  to 
advance  students  5  credit  hours  (E.  E.  Jones  and  Mr.  John 
E.  Evans). 

5.  'School  of  Orthogenics,'  for  diagnosis,  laboratory  study, 
observation  and  training  of  a  'limited  number  of  defectives.' 


42      MENTAL  HEALTH  OF  SCHOOL  CHILD 

University  of  Michigan 

1.     No. 

3.  No. 

4.  'Education  of  Backward  and  Defective  Children,'  since 
July,  1911,  2  hours  for  one  semester  (C.  S.  Berry). 

5.  No,  but  a  class  for  backward  children  in  an  affiliated 
public  school  is  open  to  students  for  observation. 

Dr.  Berry  has  recently  been  appointed  consulting  psycholo- 
gist to  the  public  schools  of  Detroit  and  to  the  Michigan  Home 
for  Feeble-Minded  and  Epileptics,  at  Lapeer.  Courses  for  the 
training  of  teachers  will  be  offered  at  the  latter  institution 
during  the  summer  of  1914. 

University  of  Montana 

4.  'Mental  Pathology,'  2  hours  for  one  semester;  visits  to 
institutions  (Bolton). 

'Exceptional  Children,'  lectures  and  laboratory  work, 
summer  term,  1913. 

6.  Will  establish  a  clinic  at  the  University.  Director, 
Thaddeus  L.  Bolton,  Professor  of  Psychology  and  Education 
(Ph.D.  in  psychology). 

Courses  are  offered  during  the  summer  term. 

University  of  Nevada 

4.  Lectures  on  exceptional  children  in  course  in  'Child  and 
Adult  Psychology,'  during  six  weeks,  in  Department  of  Psy- 
chology (George  Ordahl). 

University  of  North  Carolina 

1.  Have  tested  suspected  cases  in  several  city  school  sys- 
tems and  have  induced  Boards  to  provide  training  for  special 
class  teachers  (H.  W.  Chase). 

4.  Treated  incidentally  during  regular  and  summer  terms 
in  course  in  Educational  Psychology  (Chase). 


NEW  CLINICAL  PSYCHOLOGY  43 

University  of  Oregon 

4.  Three  or  four  lectures  on  the  subject  are  given  in  course 
in  Mental  Hygiene  and  Abnormal  Psychology  (Edmund  S. 
Conklin). 

University  of  Southern  California 

4.  'Education  of  Exceptional  Children/  given  since  1911- 
1912,  2  hours  for  one  semester;  visits  to  institutions  (Howard 
L.  Lunt). 

University  of  Tennessee 

41.  Was  emphasized  in  a  course  in  Child  Study  and  Adoles- 
cence given  in  summer  session  1913  (Bird  T.  Baldwin).  Two 
brief  didactic  courses  will  be  offered  during  summer  of  1914. 

University  of  Texas 

4.  These  topics  treated  only  incidentally  in  course  in 
Educational  Psychology  (J.  C.  Bell). 

Will  establish  a  clinic  in  School  of  Education. 

University  of  Utah 

6.  Legislature  has  been  asked  to  establish  a  clinic  in  the 
Department  of  Psychology  and  provide  for  didactic  courses. 
Thus  far  only  a  few  cases  have  been  examined  (Joseph 
Peterson). 

University  of  Wisconsin 

6.  Plans  already  considered  to  establish  a  Psychological 
Clinic  in  the  Department  of  Education. 

William  and  Mary  College 

4.  These  subjects  are  treated  briefly  in  the  course  in  Child 
Study  (H.  E.  Bennett). 


44<      MENTAL  HEALTH  OF  SCHOOL  CHILD 

State  and  City  Normal  Schools 

Group  I 

Colorado,   The   State    Teachers    College,    Greeley 

1.  Psychological  clinic,  established  in  1908  in  the  depart- 
ment of  psychology.  Director,  J.  D.  Heilman  (Ph.D.,  special 
training  in  clinical  psychology).  Physical  and  mental  exami- 
nations are  provided.  Children  in  the  Denver  schools  have 
been  examined  once  every  two  weeks.  One  room  with  fair 
laboratory  equipment. 

2.  About  5  hours.  One-third  of  clinician's  time  given  to 
teaching  clinical  subjects  and  two-thirds  to  teaching  other 
subjects. 

3.  'Psycho-clinical  Practice,'  elective,  2  hours,  fall  term 
(Heilman). 

4.  'Clinical  Psychology,'  since  March,  1910,  elective,  3 
hours  throughout  the  term;  also  given  to  Denver  teachers  and 
principals  (Heilman). 

Lectures  on  retardation  and  exceptional  children,  summer 
term,  1913,  by  various  psychological  specialists. 

5.  Yes.  Special  classes  for  the  feeble-minded,  backward 
and  dull,  and  for  children  with  speech,  reading,  spelling  and 
number  defects;  from  1  to  4  pupils  per  class,  although  the 
classes  for  the  dull  are  larger. 

Group  II 

California,  Los  Angeles  State  Normal  School 

1.  Since  1912  have  examined  a  few  children  from  the 
training  school  and  juvenile  court,  and  a  few  delinquent  girls 
and  feeble-minded  children.  Examiners:  Grace  M.  Fernald 
(Ph.D.  in  psychology;  special  work  in  the  Psychological  Insti- 
tute of  the  Juvenile  Court,  Chicago),  and  C.  W.  Waddle 
(Ph.D.  in  psychology  and  education).  Limited  equipment. 
Two  rooms  provided  for  in  plans  for  new  building. 


NEW  CLINICAL  PSYCHOLOGY  45 

2.  One  or  two  hours  per  week,  not  programed. 

3.  No;  a  week  or  two  in  the  course  in  Child  Study  is  given 
to  familiarize  students  with  the  signs,  and  the  means  of  dis- 
covering, physical  defects,  with  demonstrations.  A  few  stu- 
dents are  taught  to  give  psychological  tests. 

4.  Frequent  reference  to  these  topics  in  the  courses  in 
Child  Study  and  Advanced  Psychology. 

5.  Some  work  with  exceptional  children  done  in  training 
school.  One  or  two  special  rooms  provided  for  in  the  new 
training  school. 

6.  Plan  to  enlarge  work  if  the  legislature  authorizes 
extension  of  course  to  four  years. 

Michigan,  Central  State  Normal  School,  Mount  Pleasant 

1.  Clinic  conducted  by  Department  of  Psychology  and 
Education  for  testing  children  in  the  training  school. 
Examiner,  E.  C.  Rowe  (Ph.D.  in  psychology  and  education). 
Have  the  usual  supply  of  apparatus. 

2,  Four  hours  per  week. 

3.  No,  but  testing  of  pupils  in  training  school  is  observed 
by  students  of  the  Normal  Department, 

4,  'Clinical  Psychology,'  since  January,  1911,  4  hours  for 
12  weeks  (Rowe). 

6.     No. 

Group  III 
Alabama,  State  Normal  College,  Florence 

6.  It  is  possible  that  at  some  future  date  some  of  this  work 
may  be  programed. 

Connecticut,  State  Normal  Training  School,  Willimantic. 

6.  Pupil  teachers  do  individual  work  with  exceptional 
children. 


46      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Illinois 
Chicago  Normal  College 

1.  No,  this  work  is  done  by  the  department  of  child  study 
of  the  public  schools. 

2.  No  work  regularly  programed. 

3.  Students  and  instructors  (John  T.  McManis  and  Mabel 
R.  Fernald)  make  a  simple  anthropometric  and  psychological 
examination  of  normal  and  exceptional  children  in  the  courses 
in  education.  One  large  room  equipped  with  apparatus  for 
psychological  tests. 

5.  No,  we  conduct  classes  for  the  deaf  only  in  one  of  the 
practice  schools. 

Expect  to  train  teachers  for  backward  children. 

State  Normal  University,  Normal 

3.  No,  but  students  assist  in  physical  measurements. 
Physical  and  mental  data  are  entered  on  a  card  which  accom- 
panies the  child  through  the  training  school. 

Massachusetts 
State  Normal  School,  North  Adams 
5.     A  class  for  defectives  is  being  established. 

State  Normal  School,   Worcester 

4.  Two  special  lectures  and  incidental  reference  to  feeble- 
minded children,  and  an  annual  excursion  to  the  School  for  the 
Feeble-Minded  at  Waltham,  since  February,  1910  (J.  Mace 
Andress). 

Michigan 
Northern  State  Normal  School,  Marquette 

1.  A  few  pupils  in  the  training  school  have  been  tested 
since  1910  (G.  C.  Fracker). 

2.  Nominal. 


NEW  CLINICAL  PSYCHOLOGY  47 

3.  No,  but  students  are  afforded  some  training  in  giving 
the  Binet  tests. 

4.  A  few  lectures  are  given  on  exceptional  children,  and  on 
methods  of  diagnosis  and  treatment,  in  courses  in  Psychology 
and  Principles  of  Education  (Fracker  and  G,  L.  Brown).  The 
diagnosis  and  treatment  of  physical  defects  are  considered  in 
the  course  in  Hygiene  and  Sanitation. 

Western  State  Normal,  Kalamazoo 

1.  No  programed  work,  but  Binet-Simon  tests  are  used 
and  teachers  are  in  touch  with  the  problems. 

Minnesota 
State  Normal  School,  Duluth 

4.  Treated  incidentally  in  courses  in  Psychology  and 
Pedagogy. 

State  Normal  School,  Winona 

1.  No,  but  a  few  cases  have  been  examined  since  1898 
(J.  P.  Gaylord). 

5.  Some  special  provision  has  been  made  for  retarded 
(especially)  and  bright  pupils.  Open  to  observation  by 
student  teachers. 

6.  If  course  is  lengthened  will  develop  work  with  unusual 
children. 

New  York  City,  Brooklyn  Training  School  for  Teachers 

3.  Teachers  in  training  give  anthropometric  and  psycho- 
logical tests  to  pupils  in  the  ungraded  room. 

4.  'Psychology  of  Mental  Defectives,'  since  November, 
1912,  5  hours  for  six  weeks;  now  60  hours  (W.  J.  Taylor). 
Required  of  those  teachers  already  conducting  ungraded  classes 
who  may  be  designated  by  the  supervisor  of  ungraded  classes. 

5.  One  ungraded  class,  with  one  teacher  and  sixteen  pupils 
(high  grade  imbeciles  and  morons). 


48      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Oregon,  Normal  School,  Monmouth 

4.  About  five  weeks  is  devoted  to  these  topics  in  course  in 
Educational  Psychology  (E.  S.  Evenden). 

5.  A  flexible  scheme  of  grading  in  the  training  school 
allows  better  adjustment  of  work  to  the  needs  of  backward 
and  bright  pupils. 

6.  Contingent  on  growth  of  school,  it  is  planned  to  offer 
a  separate  course  in  this  work, 

Pennsylvania 

Bloomsburg  State  Normal  School,  Bloomsburg 

4f.  Treated  incidentally  in  courses  in  General  Psychology 
and  Child  Study. 

East  Stroudshurg  State  Normal  School,  East  Stroudsburg 

4.  Incidental  attention  is  given  in  course  in  Educational 
Psychology  to  tests  of  intelligence,  and  methods  of  studying 
and  training  exceptional  children  (D.  W.  LaRue). 

Indiana  State  Normal  School,  Indiana 

4.  Brief  presentation  of  subject  of  defective  eyes  and  ears 
to  senior  class  in  Methods,  since  fall  of  1911   (Frank  Drew). 

Millersville  State  Normal  School 

4.  Incidental  lectures  in  pedagogical  courses  on  the  Psy- 
chology of  Abnormal  and  Subnormal  Children. 

Philadelphia  Normal  School  for  Girls 

4.  The  mental  and  physical  differences  of  children  are 
studied  in  the  course  in  Child  Study.  Students  are  given 
some  training  in  giving  tests,  since  1910  (Grace  Hamill). 


NEW  CLINICAL  PSYCHOLOGY  49 

Washington^  State  Normal  School,  Bellingham 

4.  No,  but  Binet  and  deSanctis  tests  are  used  in  a  course 
in  Child  Study  (Frank  Deerwester). 

5.  Special  attention  is  given  to  dull,  bright  and  peculiar 
children  in  the  training  school. 

West  Virginia,  Training  School  of  Marshall  College, 
Huntington 

6.  Plan  to  develop  some  phases  of  this  work  in  future. 

Wisconsin,  State  Normal  School,  Milwaukee 

6.  Psychological  Laboratory  is  gradually  being  equipped 
and  some  clinical  work  may  be  done  next  year  (W.  T. 
Stephens). 

Medical  Schools 
Group  I 
Columbia  University,  College  of  Physicians  and  Surgeons 

1.  Clinic  in  psychology  and  psychotherapy,  conducted  in 
the  Vanderbilt  Clinic  (out-patient  department  of  the  college), 
since  1908,  especially  for  the  examination  of  the  'exceptional 
and  psychopathic  child'  (idiotic,  imbecile  and  psychotic  chil- 
dren are  not  received).  Director,  J.  V.  Haberman  (M.D., 
Columbia  and  Berlin),  and  several  assistants. 

2.  From  9.20  to  12.00  a.m.  three  days  a  week. 

3.  Yes,  in  connection  with  clinic  and  didactic  course. 

4.  'Psychopathology  and  Therapy,'  which  includes  mental 
examination  methods  and  pedagogical  treatment,  since  1909, 
optional  in  fourth  year,  2  hours  during  one-quarter  year 
(Haberman). 

5.  No. 


50      MENTAL  HEALTH  OF  SCHOOL  CHILD 

6.  Hope  in  near  future  to  affiliate  with  (a)  Children's 
Courts,  for  the  purpose  of  examining  the  psychopathic  cases ; 
and  (b)  the  public  schools,  for  the  purpose  of  examining  and 
treating  children  afflicted  with  abnormalities  of  disposition, 
the  psychopathic  constitutions  of  Ziehen  (rather  than  the 
mentally  defective  and  backward),  who  if  not  given  timely 
treatment  tend  to  recruit  our  classes  of  hystericals,  instables, 
delinquents,  criminals  and  the  insane.  A  very  interesting 
program  which,  however,  will  not  touch  the  psycho-educational 
problem  of  many  educational  deviates. 

Harvard  Medical  School 
See  Harvard  University,  p.  34. 

Johns  Hopkins  Medical  School 

See  Jolins  Hopkins  University  and  Phipps  Psychiatric 
Institute,  p.  30. 

New   York  Post-Graduate  Medical  School  and  Hospital 

1.  Clinic,  since  May,  1911;  has  served  as  clearing  house 
for  the  New  York  Department  of  Public  Charities  since 
January,  1913.  It  is  reported  to  be  a  'part  of  the  city  system 
of  caring  for  the  feeble-minded  children'  at  Randall's  Island. 
Director,  Max  Schlapp,  M.D.,  assisted  by  seven  neurologists 
and  three  psychologists.  Twelve  clinic  rooms  and  a  'com- 
pletely equipped  laboratory.' 

2.  Every  day  from  9.00  a.m.  to  1.00  p.m. 

3.  Graduates  in  medicine  are  permitted  to  witness  the 
examinations. 

4.  'Amentia,  Dementia  and  Exceptional  Children,'  daily 
(Schlapp). 

5.  No,  we  attempt  supervision  of  the  classes  in  the  city 
residential  institution  for  the  feeble-minded. 


NEW  CLINICAL  PSYCHOLOGY  51 

University  of  Chicago,  Rush  Medical  College 

1.  Clinic  started  in  the  fall  of  1912^  as  part  of  neurological 
department.  Two  rooms,  with  psychological  and  neurological 
apparatus.  Clinician  in  charge,  Josephine  E.  Young  (M.D., 
supplementary  work  in  psychology  in  the  University  of 
Chicago  and  Columbia  University).  'No  clinical  psychologist 
as  such.'  No  data  as  to  what  percentage  of  the  work  is  strictly 
psycho-educational. 

2.  Two  periods  per  week. 

3.  None  as  yet. 

4.  None.  Later  will  give  a  course  to  medical  students  in 
psychological  methods  of  examination,  eugenics  and  the  path- 
ology of  the  feeble-minded. 

5.  Conduct  a  class  Saturday  mornings  for  all  grades,  one 
teacher. 

6.  As  soon  as  the  money  is  available,  expect  to  organize  a 
well-equipped  school,  with  a  specially  trained  teacher  in 
charge,  assisted  by  cadets  from  the  University  of  Chicago. 
Will  also  engage  a  field  worker  who  will  see  that  patients 
report  at  the  referred  medical  clinics  and  that  they  receive 
proper  care  and  attention  at  home.  Aim  to  work  in  the  school 
classes  with  border-line  cases  difficult  to  diagnose,  and  with 
small  groups  of  low-grade  children.  The  latter  will  come 
two  or  three  times  a  week  with  their  mothers,  who  will  be 
instructed  by  the  teachers  how  to  care  for  the  pupils  at  home. 
Ultimately  hope  to  have  a  small  institution  where  research 
can  be  prosecuted. 

Yale  University  Medical  School 

1.  Psychological  clinic  conducted  by  the  Department  of 
Education  in  the  New  Haven  Dispensary,  since  April,  1912 
(Arnold  GeseU,  Ph.D.). 

3.  No. 

4.  None. 

5.  No. 


52      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Students  entering  the  medical  school  without  elementary 
psychology  are  required  to  take  such  a  course  in  the  university. 
A  course  on  the  physiology  of  the  special  senses  is  given  in  the 
psychological  laboratory  to  second-year  students  (R.  P. 
Angier,  Ph.D.). 

Group  II 

Georgetown  Medical  College 

1.  No  purely  psychological  clinic,  but  the  'Child  Study 
Laboratory'  in  the  dispensary  division  of  the  University  Hos- 
pital affords  opportunities  for  giving  the  Binet-Simon  tests 
and  an  anthropometric  and  physical  examination  to  children 
who  are  referred  because  they  do  not  get  along  well  at  home 
or  in  school.  By  D.  Percy  Hickling,  M.D.,  J.  J.  Madigan, 
M.D.,  and  Miss  Margaret  Stewart  (public  teacher  in  ungraded 
schools).  Surgical  and  medical  treatment  is  afforded  in  the 
dispensary;  parent  or  guardian  is  told  how  to  apply  hygienic 
treatment. 

3.  Cases  examined  in  the  child-study  laboratory  are 
exjjlained  in  clinics  given  to  the  fourth-year  class. 

4.  'Psychiatry/  including  facts  of  psychology,  60  hours 
each  year,  to  third-  and  fourth-year  classes  (Wm.  A.  White, 
M.D.,  and  Hickling). 

5.  No,  but  cases  are  recommended  to  'imgraded'  classes,  or 
sometimes  mothers  are  instructed  in  home  treatment  and 
training. 

Two  years  of  required  work  for  entrance  involves  a  certain 
amount  of  instruction  in  psychology. 

University  of  Michigan,  State  Psychopathic  Hospital 

1.  This  hospital  is  available  for  mentally  abnormal  and 
insane  children. 

Psychology  required  for  entrance  in  the  Medical  School. 


NEW  CLINICAL  PSYCHOLOGY  53 

Group  III 
Boston  University  School  of  Medicine 

4.  Incidental  reference  in  courses  in  Nervous  and  Mental 
Hygiene.  'Psycho-analysis  and  Psychotherapy/  since  1913- 
1914  (A.  S.  Boomhower-Guilbord,  M.D.). 

5.  No. 

Cornell  University  Medical  College 

1.  No  psychological  clinic,  but  abnormal  children  from 
the  schools  are  frequently  referred  to  out-patient  clinic  for 
examination  and  advice  (C.  L.  Dana,  M.D.,  and  August  Hoch, 
M.D.). 

Hahnemann  Medical  College,  Chicago 

1.     No,  not  apart  from  other  clinical  work. 
4.     None. 

6.  Are  planning  to  organize  didactic  and  clinical  courses 
in  a  department  of  psychology  for  the  study  and  care  of 
exceptional  children  and  all  kinds  of  mental  deviates. 

New  York  Homoeopathic  Medical  College  and  Florver  Hospital 

1.     No. 

3.  No. 

4.  Treated  only  incidentally  in  courses  in  Neurology  and 
Psychiatry. 

Tufts  College  Medical  School 

4.  'Mental  Diseases,'  lectures  with  eight  or  ten  clinics  at 
the  Boston  State  Hospital,  and  two  clinics  on  defective  children 
at  the  Massachusetts  School  for  Feeble-Minded  Children, 
from  January  1  to  May  15  (Edward  B.  Lane,  M.D.,  assisted 
by  Walter  E.  Fernald,  M.D.). 

'Psychopathology  and  Psychotherapeutics'  (Morton  Prince, 
M.D.,  J.  J.  Thomas,  M.D.,  and  A.  W.  Fairbanks,  M.D.). 


54      MENTAL  HEALTH  OF  SCHOOL  CHILD 

University   of  Buffalo,  Medical  Department 

6.  Now  conduct  a  psychiatric  clinic,  and  plan  to  open  a 
psychological  clinic  with  laboratory  equipment  in  the  dis- 
pensary for  the  examination  of  exceptional  children. 

University  of  Wisconsin,  Medical  School 

1.     No. 

4.  A  course  in  Psychology  is  given  to  medical  students 
which  includes  reference  to  methods  of  psychological  diagnosis 
(Joseph  Jastrow).    Also  a  course  in  Abnormal  Psychology. 

Washington  University,  Medical  School 

6.  Plans  are  gradually  crystallizing  for  the  development 
of  a  psychological  clinic. 

Results  and  Conclusions 

It  is  difficult  to  state  unequivocally  from  the  returns 
just  how  many  genuine  psychological  clinics  there  are  in 
the  higher  educational  institutions  of  the  country.  The 
difficulty  is  due  to  the  fact  that  the  psychologists,  educa- 
tionists and  physicians  do  not  as  yet  have  a  clear  idea — a 
definite  standard — as  to  what  constitutes  a  psychological 
clinic.  The  physician  tends  to  confuse  the  neurological 
clinic,  and  especially  to  identify  the  psychiatric  or  psycho- 
pathological  clinic,  with  the  psychological  clinic.  He 
inclines  to  the  view  that  no  special  preparation  is  needed 
to  conduct  a  psychological  clinic  for  the  examination  of 
mentally  exceptional  school  children,  beyond  taking  the 
ordinary  courses  in  neurology  and  psychopathology, 
learning  how  to  administer  a  few  stock  tests  in  psychology 
and  spending  a  few  days  visiting  psychological  clinics. 
Ninety-nine  out  of  every  hundred  physicians  have  no  tech- 


NEW  CLINICAL  PSYCHOLOGY  55 

nical  knowledge  of  those  branches  of  psychology  and  peda- 
gogy which  bear  on  the  teaching  of  educationally  excep- 
tional children.  As  a  result  we  are  today  confronted  with 
an  anomalous  situation  throughout  the  country ;  medical 
inspectors  and  physicians,  very  few  of  whom  have  any 
special  training  in  neurology  and  psychopathology  and 
nearly  all  of  whom  lack  technical  training  in  education, 
are  attempting  to  differentiate  educationally  exceptional 
children  in  the  schools  and  to  direct  their  educational  train- 
ing. It  ought  to  be  evident  to  anyone  who  has  worked  in 
the  neurological,  psychopathological  and  psychological 
clinics,  or  who  has  taken  serious  pains  to  inform  himself, 
that  the  methods  of  examination  employed  in  these  three 
clinics  frequently  differ  very  widely,  while  the  standpoint 
and  aims  of  the  examinations  often  have  little  in  common. 
Owing  to  these  confusions  medical  schools  are  inchned  to 
report  that  they  have  psychological  clinics  when  the  cUnics 
are  really  neurological  or  psychopathological  clinics. 

Again,  the  psychologist  or  educationist  is  inclined  to 
regard  a  psychological  or  educational  laboratory — any 
room  containing  psychological  and  educational  apparatus 
and  test  materials,  and  a  psychologist  or  educationist — as 
a  psychological  clinic,  although  it  ought  to  be  evident  that 
a  psychological  laboratory  and  an  experimental  psycholo- 
gist no  more  constitute  a  psychological  clinic  than  do  an 
anatomical  laboratory  and  an  anatomist  constitute  a 
medical  clinic.  The  psychologist  also  seems  to  feel  that 
he,  too,  is  qualified  to  mentally  examine  children  without 
special  training  in  mental  examination  methods,  and  in 
case-taking  and  in  clinical  procedure.  He  seems  to  think 
that  the  ordinary  courses  in  psychology  and  education 
prepare  him  for  this  work  (most  of  the  respondents  did 
not    answer   the   question    regarding   the    character    and 


56      MENTAL  HEALTH  OF  SCHOOL  CHILD 

extent  of  the  special,  technical  training  possessed  by  the 
director  of  the  clinic,  whether  the  latter  was  a  psychologist 
or  a  physician).  In  consequence  of  these  opinions  certain 
universities  report  that  they  have  a  psychological  clinic 
although  the  examiner  has  no  special  training  for  the 
work.  In  other  institutions  the  practice  obtains  of 
parceling  out  the  clinical  examination  work  among  the 
members  of  the  departmental  staff,  none  of  whom  may 
have  definitely  prepared  for  the  work.  The  fact  is  that 
we  have  recently  developed  a  new  type  of  clinical  work 
without  the  full  recognition  that  it  cannot  successfully  be 
done  by  either  the  physician  or  the  psychologist  without  a 
definite  technical  preparation.  The  time  must  come  when 
the  work  of  educational  diagnosis  and  guidance  for  men- 
tally and  educationally  exceptional  children  will  not  be 
entrusted  to  physicians  who  have  no  definite  preparation  in 
psychology  and  education,  or  to  psychologists  or  educators 
who  are  wholly  lacking  in  clinical  training  and  experience. 
We  are  met  with  a  further  diflficulty  in  attempting  to 
evaluate  the  existing  clinics :  some  of  the  clinics  are  devot- 
ing a  bare  hour  or  two  per  week  to  clinical  work,  while  the 
remaining  time  of  the  cKnicist  is  given  to  teaching,  usually 
branches  quite  remote  from  clinical  psychology  and  the 
education  of  juvenile  mental  deviates.  With  these  clini- 
cists  the  clinical  work  is  entirely  incidental,  albeit  the 
laboratory  may  have  been  established  as  a  bona  fide  clinic. 
It  is  evident  that  a  clinic  in  which  the  actual  work  of 
psycho-educational  examination  is  regarded  as  a  mere  by- 
play to  teaching,  to  be  indulged  in  an  hour  or  two  a  week, 
cannot  afford  even  sufficient  practice  to  keep  the  clinicist 
instrumentally  efficient.  It  is,  therefore,  only  by  a  liberal 
construction  that  such  an  exercise  can  be  called  a  clinic. 
Fortunately  some  of  the  laboratories  in  higher  institutions 


NEW  CLINICAL  PSYCHOLOGY  57 

of  learning  are  devoting  themselves  very  largely  if  not 
exclusively  to  clinical  work.  In  the  University  of  Wash- 
ington seven-eighths  of  the  director's  time  is  devoted  to 
the  actual  examination  of  cases ;  the  clinic  is  supplied  with 
a  considerable  staff  of  assistants,  and  all  the  teaching 
courses  of  the  director  are  limited  to  the  study  and  educa- 
tion of  exceptional  children.  At  the  University  of  Pitts- 
burgh about  two-thirds  of  the  director's  time  has  thus  far 
been  given  to  the  work  of  cHnical  examination  and  to  the 
supervision  of  the  examination  and  investigation  of  chil- 
dren, but  two  courses  foreign  to  the  department  have 
temporarily  been  carried.  The  ideal  university  clinics, 
from  the  standpoint  of  the  amount  of  time  actually  given 
to  clinical  examinations,  are  those  of  the  University  of 
Pennsylvania,  the  University  of  Washington,  the  Univer- 
sity of  Minnesota  (save  for  the  division  of  the  work  among 
several  experimental  psychologists  rather  than  its  assign- 
ment to  a  duly  qualified  specialist),  and  the  University  of 
Pittsburgh. 

Recognizing  that  the  definition  and  standards  of  any 
science  must  be  more  or  less  fluid  during  its  early  stages 
of  development,  it  has  seemed  advisable  to  place  a  rather 
liberal  construction  on  what  constitutes  a  psychological 
clinic  and  this  has  been  done  in  the  grouping  attempted 
in  the  above  classification.  Accepting  this  grouping  as 
approximately  correct  we  have  today  in  the  higher  insti- 
tutions of  learning  nineteen  psychological  clinics  in  Group 
I  and  seven  in  Group  II,  or  a  total  of  twenty-six  (exclusive 
of  Girard  College). 

Sixteen  of  the  clinics  are  in  universities.  Thirteen  of 
these  are  in  Group  I,  namely  those  of  the  University  of 
Pennsylvania,  Washington,  Minnesota,  Kansas,  Leland 
Stanford,  Missouri,  Pittsburgh,  Yale,  Cincinnati,  Tulane, 


58      MENTAL  HEALTH  OF  SCHOOL  CHILD 

North  Dakota,  Iowa  and  Oklahoma.  Three  are  in  Group 
II:  Clark,  Cornell  and  New  York  University.  Seven  are 
in  medical  schools.  Of  these  five  are  in  Group  I:  the 
Vanderbilt  CHnic  of  the  College  of  Physicians  and  Sur- 
geons of  Columbia  University,  the  Psychopathic  Hospital 
connected  with  the  Harvard  Medical  School,  the  Phipps 
Psychiatric  Institute  of  the  Johns  Hopkins  Hospital  and 
Medical  School,  New  York  Post-Graduate  Medical  School, 
Rush  Medical  College  of  the  University  of  Chicago;  and 
two  are  in  Group  II :  Georgetown  Medical  School  and  the 
State  Psychopathic  Hospital  of  the  University  of  Miclii- 
gan.  Three  are  in  normal  schools:  one  in  Group  I,  Colo- 
rado State  Teachers  College;  and  two  in  Group  II:  Los 
Angeles  State  Normal  School  and  Mount  Pleasant,  Michi- 
gan, State  Normal  School.  It  is  thus  evident  that  over 
61  per  cent  of  the  psychological  clinics  in  the  higher 
educational  institutions  are  in  the  universities. 

Fourteen  of  the  clinics  are  in  private  institutions  and 
twelve  in  state  institutions.  All  the  clinics  in  the  normal 
schools,  one  clinic  in  the  medical  schools,  and  exactly  one- 
half  of  the  clinics  in  the  universities  (including  the  city 
institution  in  Cincinnati),  are  in  state  institutions. 

Sixteen  of  the  clinics  are  in  populous  centers  (nine 
university,  six  medical  and  one  normal),  as  against  ten  in 
small  cities  (seven  university,  two  normal  and  one  medical). 
The  urban  centers,  no  doubt,  offer  a  very  much  better  field 
than  the  rural  districts  for  the  successful  organization  of 
psychological  clinics. 

Tliirteen  of  the  clinics  are  in  departments  of  education 
(including  the  clinics  in  the  three  normal  schools),  seven 
are  in  departments  of  medicine  (including  the  Johns  Hop- 
kins and  Harvard  Clinics)  and  six  in  departments  of  psy- 
chology.   The  clinics  at  the  University  of  Washington  and 


NEW  CLINICAL  PSYCHOLOGY  59 

Yale  are  supported  by  the  department  of  education,  al- 
though the  laboratory  of  the  former  is  in  the  department 
of  psychology  and  of  the  latter  in  the  dispensary  of  the 
medical  school. 

It  is  significant  that  one-half  of  the  clinics  are  in 
departments  or  schools  of  education.  Three  years  ago  I 
expressed  the  opinion  that  the  university  clinic  dealing 
with  mentally  exceptional  children  (specifically  the  feeble- 
minded, backward,  retarded,  speech-defective,  blind,  deaf, 
precocious,  word-blind,  word-deaf,  children  with  specific 
deficiencies  in  reading,  spelUng,  number  work,  writing) 
should  preferably  be  located  in  the  school  or  department 
of  education.  I  am  more  strongly  convinced  than  ever  of 
the  wisdom  of  that  judgment.  There  seems  to  me  to  be 
no  very  convincing  reason  for  locating  the  clinic  in  the 
college  department  of  psychology.  As  well  might  we  place 
the  medical  clinics  in  the  college  department  of  biology. 
Psychology  is  a  science  rather  than  an  art,  while  the  psy- 
cho-cHnical  examination  of  children  is  primarily  an  art 
(which,  to  be  sure,  presupposes  a  groundwork  of  scientific 
knowledge),  just  as  teaching  and  medicine  are  primarily 
arts.  Moreover,  the  aim  of  a  clinic  in  the  department  of 
psychology  cannot  be  other  than  the  aim  of  a  psycho- 
educational  chnic,  namely  correct  educational  classifica- 
tion and  advice  regarding  the  corrective  pedagogical 
training  of  the  child. 

Similarly  there  is  no  very  convincing  reason  why  the 
psycho-educational  clinic  deahng  with  the  types  of  men- 
tally unusual  cases  mentioned  above  (which  are  primarily 
educational  cases  and  not  medical)  should  be  located  in 
the  medical  school,  unless  it  were  placed  in  charge  of  a 
psycho-educational  expert  thoroughly  trained  to  prescribe 
pedagogically  for  the  school  cases  examined.     To  be  sure, 


60      MENTAL  HEALTH  OF  SCHOOL  CHILD 

there  are  certain  positive  reasons  that  can  be  advanced  for 
locating  the  psychological  clinic  in  the  central  clinic  or 
hospital  of  the  medical  school :  parents  customarily  bring 
children  who  appear  to  be  'not  right'  to  medical  chnics ;  it 
facilitates  the  transfer  of  cases  coming  to  the  psychologi- 
cal clinic  which  require  medical  care  to  the  appropriate 
medical  specialists,  and,  vice  versa,  cases  coming  to  the 
medical  clinics  which  require  special  educational  care  can 
be  readily  transferred  to  the  psychological  clinic ;  it  will 
foster  greater  harmony  and  cooperation  between  examin- 
ing physicians  and  examining  psycho-educationists,  and 
this  will  remove  some  of  the  misguided  opposition  and 
unjustified  prejudice  against  the  psychological  examiner 
which  now  obtains  in  various  quarters. 

On  the  other  hand,  if  the  clinics  are  located  in  the  medi- 
cal school  they  will  frequently,  perhaps  generally,  be 
manned  by  physicians  who  are  neither  psychologists, 
educationists  nor  experts  in  the  differential  methods  of  edu- 
cating pedagogical  deviates.  On  the  whole,  the  best  plan 
for  the  organization  of  a  psycho-educational  clinic  in  a 
university  is  to  place  it  under  the  direction  of  a  well- 
trained  psychological  and  educational  examiner,  and  to 
affiliate  it  with,  or  place  it  under,  the  joint  administrative 
control  of,  the  schools  of  education  and  medicine,  or  of  the 
schools  of  education  and  medicine  and  the  department  of 
psychology. 

In  so  saying,  however,  I  A\"ish  to  voice  the  opinion  that 
every  first-class  medical  school  ought  to  establish  a  psy- 
chological clinic  in  conjunction  with  its  clinics  in  neurol- 
ogy, psychiatry  and  psychopathology,  primarily  for  the 
more  detailed  psychological  study  of  neurasthenic,  psy- 
chotic, psychopathic  and  psycho-neurotic  cases,  and  only 
secondarily  for  the  study  of  the  types  of  cases  which  appeal 


NEW  CLINICAL  PSYCHOLOGY  61 

primarily  to  the  educational  clinic.  The  director  of  the 
medical  school  psychological  clinic  (preferably  a  neurolo- 
gist or  psychopathologist  with  extensive  training  in 
normal,  abnormal  and  chnical  psychology)  should  offer 
didactic,  clinical  and  experimental  courses  (covering 
mental  tests  and  psychological  diagnosis)  to  all  students 
speciahzing  in  psychiatry,  psychopathology,  psychas- 
thenics, neurology  and  psychotherapy. 

Not  only  have  the  medical  schools  of  the  country 
neglected  adequately  to  pro\'ide  for  these  and  allied 
courses  for  students  specializing  in  psychopathology  (our 
returns  indicate  that  about  a  dozen  medical  schools  are 
attempting  a  certain  amount  of  this  instruction  and 
training;  possibly  a  couple  of  dozen  schools  in  this  coun- 
try are  offering  measurably  satisfactory  courses)  ;*'  but 
until  recently  any  student  who  did  not  have  the  bachelor's 
degree  could  graduate  in  any  medical  school  in  the  coun- 
try without  having  taken  a  single  systematic  course  in 
psychology — a  fact  which  physicians  themselves  have 
lamented  (Jones,  Munro,  Taylor,  17,  22,  27,  4).  'Most 
physicians  are  given  not  five  minutes'  training  in  psy- 
chology in  the  five  years  of  their  student  life.  There  is 
no  teacher  of  clinical  psychology  in  any  medical  school  in 
the  country'  (Jones).  The  average  physician  probably 
has  less  technical  knowledge  of  the  science  of  psychology 

8  See,  however,  the  recent  report  of  the  committee  of  physicians  and 
psychologists  appointed  by  the  American  Psychological  Association 
(7) :  'It  is  apparent  that  students  and  graduates  in  medicine  who 
incline  toward  practice  in  diseases  of  the  mind  and  nervous  system 
have  few  or  no  opportunities  in  the  medical  schools  in  this  country 
to  acquire  a  broader  acquaintance  with  the  subjects  of  neurology  and 
psychiatry,  than  the  clinical  courses  which  are  offered.'  'At  present 
the  teaching  of  psychiatry  appears  to  be  in  an  earlier  stage  than 
surgery  was  in  the  two-  or  three-year  course  in  medicine  twenty 
years  ago.' 


62      MENTAL  HEALTH  OF  SCHOOL  CHILD 

than  the  average  city  grade  teacher — all  normal  school 
graduates  have  been  required  to  take  at  least  one  system- 
atic course  in  psychology.  And  yet  the  physician  is 
expected  to  minister  not  only  to  the  bodily  but  also  to  the 
mental  well-being  of  his  patient.  Happily  the  situation  in 
the  medical  schools  is  gradually  changing  for  the  better. 
Franz  finds  in  his  recent  census  that  'ten  medical  schools 
have  already  introduced,  or  plan  to  introduce  next  year, 
psychology  into  the  curriculum  or  require  it  for  entrance, 
and  one  advises  students  to  take  a  course  in  psychology  in 
the  preparatory  premedical  years.'  Moreover,  of  the 
sixty-eight  medical  deans  or  professors  who  answered  the 
question,  75  per  cent  favored  giving  the  medical  students 
special  instruction  in  psychology,  while  only  10  per  cent 
gave  negative  and  15  per  cent  qualified  affirmative  or 
negative  replies  (7). 

There  is,  therefore,  no  need  to  hold  a  brief  for  the 
introduction  of  a  required  course  in  psychology  for  all 
the  students  in  the  premedical  or  medical  curriculum.  But 
it  is  well  to  reemphasize  that  the  medical  schools  should 
make  distinctly  better  provisions  for  teaching  the  special- 
ties in  psychology  for  students  preparing  to  specialize  on 
mental  cases.  In  justification  of  this  contention  it  is  only 
necessary  to  say  that  it  is  becoming  generally  recognized 
that  the  malfunctioning  of  mental  processes  may  play  a 
dynamic  role  in  the  production  of  certain  nervous  and 
mental  disorders,  and  that  mental  factors  play  an  impor- 
tant role  in  therapy  (psychotherapy).  The  influence 
of  suggestion,  mental  strife,  latent  complexes,  suppressed 
wishes,  morbid  fears,  obsessions,  etc.,  in  the  causation  of 
certain  forms  of  abnormal  behavior  has  been  established 
by  the  researches  of  Freud  and  Jung  and  many  of  their 
followers,    by    the    clinical    observations    and    results    of 


NEW  CLINICAL  PSYCHOLOGY  63 

Dubois  (5)  and  of  other  medical  practitioners,  and  by  the 
net  results,  however  distorted,  exaggerated  and  unreliable 
most  of  the  reports  are,  of  healing  cults  of  a  pseudo- 
scientific  character  (24). 

Among  the  disorders  which  are  now  believed  by  many  to 
be  largely  psychogenic  in  origin  are  the  neuroses  proper 
(neurasthenia  and  anxiety  neuroses,  both  related  to  dis- 
ordered sexuahty,  according  to  the  Freudians),  the 
psycho-neuroses  (classical  or  Freudian  conversion  hys- 
teria, anxiety  hysteria  and  compulsion  neuroses,  all  re- 
lated, so  says  Freud,  to  suppressed  yearnings  or  wishes 
of  a  sexual  nature),  the  lighter  forms  of  hypochondria  and 
melancholia,  and  various  disequilibrations  bordering  on 
insanity.  Since  the  pathology  seems  to  be  partly  or 
wholly  psychogenic,  the  treatment  of  these  disorders  must 
be  partly  or  wholly  ideogenic.  It  must  consist  in  the 
modification  of  the  patient's  abnormal  stream  of  thought, 
his  faulty  associative  mechanisms,  his  morbid  emotional 
complexes  and  attitudes  and  his  perverted  instinctive 
reactions,  by  the  methods  of  suggestion,  reeducation  or 
psycho-analysis.  The  efficacy  ascribed  to  drugs,  physical 
agencies,  'healing  thoughts,'  or  'absent  treatment'  in  the 
treatment  of  the  true  psycho-neuroses  probably  comes 
from  the  force  of  suggestion:  the  innate  impulsiveness  or 
tendency  of  ideas  to  express  themselves  in  appropriate 
physiological  adjustments  or  glandular  activities  (the  law 
of  dynamogenesis).  Whatever  the  explanation,  there  is 
nothing  occult  in  scientific  psychotherapy :  it  is  a  legiti- 
mate division  of  psychology  and  medicine.  The  successful 
operator  must  be,  first  and  foremost,  a  skilled  clinical  or 
medical  psychologist.  He  must  be  able  to  inspire  con- 
fidence by  his  manner  and  by  a  correct  diagnosis  and 
prognosis,  to  awaken  hope  by  emphasizing  the  favorable 


64      MENTAL  HEALTH  OF  SCHOOL  CHILD 

symptoms  throughout  the  course  of  the  treatment,  to 
remove  conflicting  thoughts  and  suggest  appropriate 
thoughts,  to  bring  to  the  surface  and  to  dissipate  psychic 
complexes  which  cause  mental  strife,  etc.  Mental  hygiene 
and  therapy  should  not  be  left  to  dilettante  and  fakirs,  as 
has  been  done:  in  psychotherapy  'the  pubUc  has  been  left 
largely  to  its  own  devices,  to  become  the  victims  of  Chris- 
tian Scientists  and  dabblers  in  the  occult,  or  misguided 
clergymen.'  Various  forms  of  mental  affliction  which  have 
baffled  medical  skill  have  been  left  to  untrained  empirics 
and  irregular  practitioners,  because  medical  curricula 
have  made  little  provision  for  training  physicians  in  the 
scientific  mental  therapy  of  psychic  disorders.  In  conse- 
quence, we  have  for  years  been  reaping  a  rich  harvest  of 
pseudo-psychotherapies. 

If  now — to  repeat — suggestion  and  psycho-analysis  are 
the  basal  principles  in  the  psychic  treatment  of  the  above 
varieties  of  mental  disorders,  and  suggestive  and  psycho- 
analytic therapeutics  are  a  legitimate  branch  of  psy- 
chology and  medicine,  the  conclusion  follows  that  every 
complete  medical  school  should  make  provision  for  instruc- 
tion and  training  in  the  science  and  art  of  psychological 
medicine.  One  of  the  divisions  in  the  department  of  psy- 
chological medicine  should  be  a  laboratory  of  clinical  psy- 
chology, in  which  the  student  may  receive  training  in  the 
psycho-clinical  and  psycho-laboratory  methods  of  examin- 
ing patients.  Training  should  be  afforded  in  the  methods 
used  for  testing  specific  mental  deviations,  for  ascertaining 
the  extent  of  the  involution  changes  resulting  from  various 
dementias,  and  for  measuring  the  degree  of  subnormality 
and  supernormality.  Practice  should  be  given  in  the 
hypnotic,  psycho-analytic  and  association-reaction  meth- 
ods   of   mental    diagnosis    and    treatment,    possibly    with 


NEW  CLINICAL  PSYCHOLOGY  65 

some  attention  to  the  psychomotor  or  galvanometric  tests. 
Lectures  should  be  given  on  the  psychological  and  thera- 
peutical aspects  of  suggestion,  psycho-analysis,  hypnotism 
or  any  of  the  methods  which  enable  us  to  lay  bare  dormant, 
unrecognized,  suppressed  mental  complexes  or  conflicts, 
disorders  and  blockages  in  the  associative  mechanism, 
tendencies  toward  repetition  or  perseveration  of  test 
words,  sensory  and  motor  automatisms,  dissociation  phe- 
nomena, obsessions,  fixed  ideas,  phobias  and  confusions, 
and  which  will  enable  us  to  construct  a  differential  psy- 
chology of  various  psychic  disorders.  When  the  medical 
schools  have  given  proper  attention  to  these  matters, 
psychological  criteria  will  attain  a  diagnostic  value  which 
they  do  not  yet  possess. 

In  attempting  to  determine  how  many  institutions  are 
conducting  training  clinics  for  preparing  students  to  psy- 
chologically and  educationally  examine  mentally  excep- 
tional children,  we  are  again  obliged,  because  of  the  vague 
standards  of  what  a  psychological  training  clinic  is,  to 
attempt  an  evaluation  of  the  existing  clinics.  Some  insti- 
tutions offer  merely  didactic,  demonstration  or  experi- 
mental courses  in  mental  tests  and  regard  these  as  training 
clinics ;  some  institutions  have  the  students  test  and  experi- 
ment upon  each  other  and  regard  these  exercises  as  train- 
ing clinics;  and  others  open  their  dispensary  clinics  (often 
neurological  or  psychopathological  rather  than  psycho- 
logical or  psycho-educational)  to  students  for  observation, 
and  regard  these  as  training  clinics.  It  is  clear  that  a 
genuine  psychological  (or  psycho-educational)  training 
clinic  must  afford  students  training  in  studying  actual 
cases  of  mental  deviation  by  the  methods  of  psychological 
observation,  testing  and  experimentation;  it  must  afford 
training  in  the  larger  aspects  of  case-taking  and  clinical 


66      MENTAL  HEALTH  OF  SCHOOL  CHILD 

procedure ;  it  must  have  access  to  a  large  variety  and  an 
ample  supply  of  clinical  material ;  and  it  must  provide 
instruction,  supervision  and  guidance  at  the  hands  of  an 
expert  psycho-clinical  (and  psycho-educational)  diagnos- 
tician. It  is  evident  that  a  student  who  has  been  trained 
in  a  clinic  frequented  by  a  limited  number  of  feeble-minded 
or  backward  children  may  be  entirely  ignorant  of  the  great 
variety  of  perplexing  cases  of  mentally  and  educationally 
exceptional  children  which  are  certain  to  come  to  the 
psychological  clinic  in  the  large  urban  centers.  And  it  is 
entirely  clear  to  my  mind  that  no  student  can  be  gradu- 
ated from  a  university  psycho-educational  clinic  as  a 
thoroughly  competent  examiner  unless  he  has  made  first- 
hand studies  during  an  extended  period  of  time  (from  two 
to  four  years,  certainly  not  less  than  two)  of  a  great 
variety  of  educationally  unusual  children — feeble-minded, 
border  cases,  backward,  dull,  normal,  precocious,  epilep- 
tic, aphasic,  speech-defective,  etc. 

The  best  provisions  for  training  students  in  the  art  of 
psychological  diagnosis  are  probably  offered  in  the  fol- 
lowing institutions :  University  of  Pennsylvania,  University 
of  Washington  and  University  of  Pittsburgh.  New  York 
University  offers  good  opportunities  during  the  summer 
session — but  the  period  is  entirely  too  limited  to  make  it 
possible  to  train  experts.  Among  the  other  institutions 
reporting  which  afford  students  more  or  less  opportunity 
for  making  observations,  for  conducting  clinical  examina- 
tions, or  for  making  psychological  tests  and  experiments 
are  the  following:  the  universities  of  Minnesota,  Missouri, 
Yale,  Leland  Stanford,  Cincinnati  and  Cornell;  the  Col- 
lege of  Physicians  and  Surgeons  of  Columbia,  the  Psycho- 
pathic Hospital  of  Harvard,  the  Phipps  Clinic  of  Johns 
Hopkins,   the   New   York  Post-Graduate   Medical   School 


NEW  CLINICAL  PSYCHOLOGY  67 

and  Hospital  and  the  Georgetown  Medical  College ;  the 
State  Teachers  College  of  Colorado,  the  Brooklyn  Train- 
ing School,  the  Marquette,  and  Mount  Pleasant,  Michigan, 
State  Normal  Schools,  the  Los  Angeles  State  Normal 
School,  the  Chicago  Normal  College  and  the  Philadelphia 
Normal  School  for  Girls, 

Classes  for  the  purpose  of  training  subnormal  children 
and  for  affording  opportunities  for  observation  are  con- 
ducted in  the  following  universities :  University  of  Penn- 
sylvania, University  of  Washington,  University  of 
Indiana,  New  York  University  (summer  session).  Uni- 
versity of  Pittsburgh  (summer  session)  and  the  Uni- 
versity of  California  (summer  session)  ;  in  the  follow- 
ing normal  schools :  Brookl3'n  Training  School,  Los 
Angeles  Normal  School,  the  State  Teachers  College  of 
Colorado  and  the  North  Adams,  Mass.,  State  Normal 
School,  while  special  attention  is  given  to  exceptional  cliil- 
dren  in  the  Winona,  Minnesota,  State  Normal,  Monmouth, 
Oregon,  State  Normal  and  the  Willimantic,  Conn.,  State 
Normal;  and  in  Rush  Medical  School  (one  morning  only 
for  all  grades,  which  is  an  almost  negligible  amount). 
Clinics  in  especially  the  following  institutions  are  assisting 
public  school  systems  in  the  diagnosis  and  selection  of 
cases,  or  in  the  supervision  of  the  classes,  or  in  utilizing 
the  classes  for  purposes  of  observation :  the  University  of 
Pennsylvania,  the  University  of  Pittsburgh,  Leland  Stan- 
ford, the  University  of  Cincinnati,  the  University  of  Michi- 
gan, the  University  of  Minnesota,  the  University  of  Iowa, 
the  University  of  Washington,  Yale,  the  Phipps  Psy- 
chiatric Clinic  and  the  New  York  Post-Graduate  Medical 
School  and  Hospital. 

On  the  whole,  very  few  of  the  clinics  in  any  kind  of 
higher  institution  of  learning  have  at  their  disposal  satis- 


68      MENTAL  HEALTH  OF  SCHOOL  CHILD 

factory  'special  classes'  in  which  mentally  exceptional  chil- 
dren can  be  properly  trained,  in  which  they  can  be  studied 
under  laboratory  conditions  and  observed  in  a  superior 
educational  environment,  and  in  which  students  in  train- 
ing may  be  afforded  superior  opportunities  for  observation 
and  cadet  teaching.  Possibly  this  state  of  affairs  does  not 
invite  serious  criticism,  for  it  is  scarcely  the  function  of 
departments  of  psychology  in  the  universities  or  of  medi- 
cal schools  to  conduct  elementary  classes  for  mentally 
unusual  children.  The  duty  of  providing  training  for 
these  children  clearly  rests  with  the  pubHc  schools,  and 
(although  perhaps  not  to  the  same  extent)  with  the 
observation  and  practice  departments  of  colleges  of  edu- 
cation and  normal  schools.  It  is  very  desirable  that 
classes  for  the  educationally  exceptional  types  of  children 
be  established  in  the  practice  schools  of  the  latter  institu- 
tions, in  order  that  the  diagnosis  and  training  of  these 
children  may  receive  proper  scientific  study,  in  order  that 
opportunities  for  follow-up  work  may  be  afforded,  and  in 
order  that  proper  facilities  may  be  afforded  for  training 
special  teachers  and  expert  examiners.  But,  after  all,  the 
colleges  of  education  and  the  normal  schools  cannot  care 
for  5  per  cent  of  all  the  children  who  require  special  edu- 
cational treatment,  and  it  is  clearly  the  duty  of  the  public 
schools  to  make  adequate  provisions  for  training  'all  the 
children  of  all  the  people.' 

2.  The  psycJwlogical  laboratory  and  clinic  in  the  hos- 
pitals for  the  Hnsane.'  The  psychological  cHnic  is  rapidly 
finding  a  place  in  the  public  and  private  institutions  for 
the  mentally  diseased  and  the  mentally  defective  classes. 
In  the  hospitals  for  the  mentally  alienated  much  of  the 
recent  work  of  value  in  psychiatry  has  been  done  by  psy- 
chologists   or   by    alienists   trained    in    the   methods    and 


NEW  CLINICAL  PSYCHOLOGY  69 

imbued  with  the  spirit  of  the  new  psychology.  The 
pioneers  in  the  new  psychiatry  are  Wernicke,  who,  to  be 
sure,  recognizes  the  paramount  importance  of  physical 
etiology  in  the  consideration  of  mental  diseases,  but  finds 
it  inadequate  for  classification,  and  who  makes  the  dis- 
orders of  the  content  of  consciousness  primary  (from  him 
we  derive  the  concepts  of  psychosensory,  intrapsychic  and 
psychomotor  disorders ;  allopsychoses,  somatopsychoses 
and  autopsychoses ;  afunctional,  parafunctional  and  hyper- 
functional  disorders)  ;  Ziehen,  whose  classification  is 
thoroughly  psychological  (based  upon  the  Herbartian  and 
association  psychology)  ;  Kraepelin,  who  emploj^s  the 
methods  of  psychological  experimentation  and  the  longi- 
tudinal method  of  analysis  of  the  stream  of  consciousness 
(sequential  course)  for  making  a  composite  picture  of  the 
distinctive  traits  of  various  disease  types ;  and  Freud,  who 
has  elaborated  a  unique  method,  the  method  of  psycho- 
analysis, for  purposes  of  diagnosis  (disclosing  submerged 
morbid  mental  complexes)  and  treatment,  and  who  main- 
tains that  the  etiological  factors  in  various  neuroses  are  of 
purely  psychic  origin.  In  this  country  the  psycho-bio- 
logical conception  of  various  mental  disorders  has  been 
ably  championed  by  Adolf  Meyer,  M.D.,  the  director  of 
the  recently  opened  Phipps  Psychiatric  Clinic  at  the  Johns 
Hopkins  Hospital,  who  has  made  notable  contributions  to 
the  psychology  of  dementia  prsecox.  Among  other  psy- 
chopathologists  who  are  giving  considerable  study  to  the 
psychological  aspects  of  mental  disturbances  may  be  men- 
tioned Drs.  T.  A.  WilHams,  A.  A.  Brill,  Morton  Prince, 
I.  H.  Coriat,  Wm.  A.  White,  Smith  E.  JeUifFe,  Boris  Sidis 
and  August  Hoch  (the  director  of  the  Ward's  Island  Psy- 
chiatric Institute).  Dr.  Ernest  Jones  of  the  University  of 
Toronto  is  an  enthusiastic  exponent  of  Freudian  methods. 


70      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Psychological  laboratories,  manned  by  trained  psycholo- 
gists, have  been  estabhshed  in  the  following  institutions: 
McLean  Hospital,  Waverly,  Mass.,  since  1904,  with  F. 
Lyman  Wells,  Ph.D.,  as  director;  the  Government  Hos- 
pital for  the  Insane,  Wasliington,  D.  C,  since  January  1, 
1907,  with  Shepherd  Ivory  Franz,  Ph.D.,  as  psychologist 
and  scientific  director ;  Friend's  Asylum  for  the  Insane, 
Frankford,  Pa.  (work  temporarily  suspended),  and  the 
New  York  Psychiatric  Institute  at  Ward's  Island  (now 
apparently  without  a  psychologist).  Both  Franz  and 
Wells  have  published  a  considerable  number  of  valuable 
experimental  papers  ranging  over  a  wide  field  in  the  psy- 
chology of  mental  disease.  The  Massachusetts  General 
Hospital  maintains  a  psychologist  (L.  E.  Emerson, 
Ph.D.),  and  more  or  less  psychological  research  is  being 
conducted  at  the  King's  Park  Hospital,  in  New  York 
State,  by  A.  J.  Rosanoff,  M.  D.,  and  very  probably  in 
numerous  other  hospitals  for  the  insane  and  in  psycho- 
pathic sanitaria. 

Many  clinical  examinations  and  investigations  of  the 
alienated  and  psychopathic  are  necessarily  partly  psy- 
chological in  nature,  so  that  it  is  probable  that  psycho- 
logical research  and  psycho-clinical  examinations  are 
conducted  to  some  extent  in  the  majority  of  state  and 
private  institutions  throughout  the  country. 

3.  The  psycho-clinical  laboratory  in  institutions  for 
the  feeble-minded  and  epileptic.  The  initial  impulse 
toward  the  organization  of  laboratories  of  psychological 
research  in  these  institutions  came  from  Dr.  A.  C.  Rogers, 
who,  in  1898,  engaged  a  psychologist  (who  later  also 
qualified  as  physician),  Dr.  A.  R.  T.  Wyhe,  to  devote 
about  half  of  his  time  to  the  psychological  study  of  the 
patients  in  the  Minnesota  School  for  Feeble-Minded  and 


NEW  CLINICAL  PSYCHOLOGY  71 

Colony  for  Epileptics  at  Faribault.  The  fruits  of  Wylie's 
work,  which  continued  for  about  three  years,  appear  in  a 
number  of  studies  of  the  emotions,  instincts,  senses, 
memory,  reaction  time,  and  height  and  weight  of  the 
feeble-minded. 

The  main  impulse,  however,  toward  the  development  of 
the  work  came  from  Superintendent  E.  R.  Johnston  of  the 
New  Jersey  Training  School  for  Feeble-Minded  Boys  and 
Girls  at  Vineland  who,  in  1906,  appointed  H.  H.  Goddard, 
Ph.D.,  as  director  of  research.  The  work  in  Goddard's 
laboratory  has  progressed  uninterruptedly  during  the  last 
seven  years,  and  has  covered  a  wide  range  of  interests  in 
psychology  and  heredity.  The  laboratory  at  present 
commands  the  services  of  seventeen  men  and  women  includ- 
ing student  assistants  and  heredity  field  workers.  The 
following  divisions  have  been  organized:  psychology  (with 
Mr.  E.  A.  Doll  as  assistant  psychologist),  physiology 
(directed  by  A.  W.  Peters,  M.D.,)  and  psychopatholgy 
(directed  by  W.  J.  Hickson,  M.D.). 

The  Vineland  institution  has  also  developed  into  a  semi- 
nary of  instruction.  During  the  summer  it  offers  training 
courses  to  teachers  of  retarded  and  subnormal  cliildren, 
and  to  school  medical  inspectors.  Beginning  with  the 
summer  of  1914  only  teachers  who  have  already  specialized 
in  the  study  of  the  subnormal  will  be  admitted  to  the 
teachers'  courses.  (Other  institutions  for  the  feeble- 
minded which  recently  have  conducted,  or  are  conducting, 
training  classes  for  teachers  are  The  Herbart  Hall  Insti- 
tute for  Atypical  Children,  Plainfield,  N.  J. ;  Rome  State 
Custodial  Asylum,  Rome,  N.  Y.,  and  Michigan  Home  for 
Feeble-Minded  and  Epileptic,  Lapeer,  Mich.) 

The  result  of  the  Vineland  work  is  appearing  in  a  num- 
ber of  studies  of  the  psychology  and  heredity  of  feeble- 


72      MENTAL  HEALTH  OF  SCHOOL  CHILD 

mindedness,  including  percentile  growth  curves  of  height, 
weight,  vital  capacity,  hand  dynamometry,  endurance ; 
mental  classifications ;  heredity  charts  and  studies ;  record 
forms ;  translations  of  graded  tests  for  developmental 
diagnosis,  etc.  (10,  11,  12).  The  psychological  labora- 
tory has  a  fair  equipment  of  apparatus  and  a  well-chosen 
library  of  technical  books  and  periodicals,  domestic  and 
foreign.  This  laboratory  may  be  regarded  as  the  first 
genuine  laboratory  of  clinical  psychology  to  be  established 
at  an  institution  for  the  feeble-minded,  and  has  exerted  a 
very  wide  influence  in  its  special  field. 

Within  the  last  few  years  departments  of  psychological 
research  have  been  organized  in  a  number  of  institutions 
for  these  defectives.  In  the  fall  of  1909  a  laboratory — the 
second  of  the  sort  in  the  country — was  established  in  the 
Lincoln  State  School  and  Colony  of  Illinois,  under  the 
directorship  of  Dr.  E.  B.  Huey  (14).  This  laboratory  is 
now  in  charge  of  Dr.  Clara  H.  Town.  In  the  fall  of  1910 
the  Faribault  laboratory  was  reestablished  with  Dr.  Fred 
Kuhlmann  as  director,  and  two  new  laboratories  were 
established,  one  at  the  Iowa  Institution  for  Feeble-Minded 
Cliildren  at  Glenwood  (this  laboratory  has  been  tem- 
porarily discontinued,  but  will  probably  be  reopened  in  the 
near  future),  and  one  in  the  New  Jersey  State  Village  for 
Epileptics  at  Skillman.  The  latter  laboratory,  which  was 
organized  by  the  writer,  is  the  pioneer  psycho-clinical 
laboratory  in  colonies  for  epileptics.  The  work  in  this 
laboratory  has  been  temporarily  discontinued.  In  1914 
the  Micliigan  Home  for  Feeble-Minded  and  Epileptics 
appointed  a  consulting  psychologist  (see  p.  42). 

Among  the  private  schools  for  feeble-minded  and  back- 
ward children  which  are  making  some  provisions  for  the 
psychological  examination  of  their  pupils  may  be  men- 


NEW  CLINICAL  PSYCHOLOGY  73 

tioned  the  Bancroft  Training  School,  Haddonfield,  N.  J. 
(E.  A.  Farrington,  M.D.,  president)  and  Herbart  Hall, 
Plainfield,  N.  J.  (M.  P.  E.  Groszmann,  Pd.D.,  educational 
director). 

The  latter  institution  is  now  fostered  by  the  National 
Association  for  the  Study  and  Education  of  Exceptional 
Children.  During  the  summer  and  fall  of  1913  its  director 
traveled  extensively  throughout  the  far  West  and  North- 
west, deKvering  addresses  and  organizing  state  associa- 
tions in  affiliation  with  the  national  organization. 

Institutional  positions  in  psychological  research  offer 
certain  advantages.  The  incumbent  is  relieved  of  teaching 
duties  and  has  ready  access  to  an  abundance  of  clinical 
material.  He  may  also  count  on  the  sympathetic  coopera- 
tion of  the  governing  and  administrative  officers  of  the 
institution,  for  the  view  is  now  gaining  acceptance  that 
the  functions  of  public  hospital,  custodial,  training,  correc- 
tional and  penal  institutions  should  not  be  limited  to  the 
care,  treatment,  occupational  supervision  and  restraint  of 
the  inmates,  but  should  include  the  scientific  investigation 
of  their  present  mental  and  physical  status,  and  the  condi- 
tions and  causes  which  underlie  various  kinds  of  defective- 
ness and  delinquency.  Public  institutions  should  be 
laboratories  of  research  as  w^ell  as  places  for  treatment, 
refuge,  confinement  and  profitable  employment.  In  order 
to  be  made  attractive  centers  of  scientific  research,  how- 
ever, the  prerogatives  and  regulations  affecting  the 
research  positions  (in  respect  to  the  matter  of  stipend, 
rank,  hours  of  service,  vacations,  publishing  rights,  per- 
sonal prerogatives,  freedom  from  unnecessary  restrictions, 
and  from  the  absurd  regulations  of  tyrannically  inclined 
superintendents,  etc.)  should  be  made  to  conform  with  the 
rules  which  govern  similar  positions  in  the  universities  and 


74      MENTAL  HEALTH  OF  SCHOOL  CHILD 

research  institutions.  Only  thus  will  the  best  scientific 
talent  find  the  field  sufl5ciently  attractive  to  forsake  the 
scientific,  cultural,  Hbrary  and  laboratory  advantages 
which  the  universities  furnish  in  such  rich  measure. 
At  the  present  time  the  universities  have  practically 
a  monopoly  on  the  scientific  producers  of  the  country. 
According  to  Cattell's  statistical  study  of  American  men 
of  science,  75  per  cent  of  the  1,000  scientists  of  the  first 
rank  are  located  in  the  colleges  and  universities  (3). 
There  is  an  inviting  virgin  soil  for  scientific  investigators 
in  institutions  for  defectives.  Provided  that  proper  in- 
ducements are  offered,  these  institutions  bid  fair  to  become 
large  productive  centers  of  scientific  work  in  the  near 
future. 

So  far  as  psychological  work  is  concerned,  it  is  pertinent 
to  point  out  that  the  function  of  the  psychologist  is  to 
study  mind  in  all  its  manifestations  and  under  all  its  con- 
ditions. The  psychologist  should,  therefore,  have  the  free- 
dom of  the  institution ;  he  should  have  ready  access  to  the 
patients  in  the  cottages  or  schoolhouse  or  in  the  field,  no 
less  than  in  the  laboratory.  There  may  be  a  certain  arti- 
ficiality and  formahty  about  psycho-laboratory  work,  a 
certain  unnaturalness  in  the  attitude  or  the  reactions  of 
the  subject  toward  the  tests.  Tliis  will  sometimes  render 
the  results  one-sided  or  partial,  and,  therefore,  makes  it 
desirable  to  do  supplementary  work  under  otheF  conditions. 

4.  Clinical  psychology  in  the  juvenile  court.  The 
application  of  the  methods  of  clinical  psychology  to  the 
study  of  the  juvenile  and  adult  offender  is  making  rapid 
strides.  The  department  of  child  study  and  pedagogic 
investigation  of  the  Chicago  public  schools  has  for  years 
done  incidental  work  in  this  direction  in  connection  with 
the  schools  for  truants  and  delinquents.    The  first  labora- 


NEW  CLINICAL  PSYCHOLOGY  75 

tory  to  be  directly  connected  with  a  juvenile  court  is  the 
Juvenile  Psychopathic  Institute,  organized  in  Chicago 
in  April,  1909,  by  Dr.  Wilham  Healy,  who  secured  a 
fund  of  $30,000  with  which  to  defray  the  expenses  of  con- 
ducting clinical  examinations  of  juvenile  court  delinquents 
for  a  period  of  five  years.  It  was  considered  that  five  years 
was  sufficiently  long  to  demonstrate  the  value  of  the  work. 
Dr.  Healy,  with  the  aid  of  psychological  and  sociological 
assistants,  is  engaged  in  the  study  of  the  underlying 
factors,  physiological,  psychological,  social  and  heredi- 
tary, of  juvenile  criminaUty,  and  is  working  particularly 
^nth  the  juvenile  recidivist.  According  to  press  reports 
this  Institute  is  now  supported  by  Cook  County. 

The  city  of  Seattle  established  a  division  of  diagnosis  as 
an  integral  part,  of  its  juvenile  court  in  1911,  with  Dr. 
Lilburn  Merrill  as  director,  and  Dr.  Stephenson  Smith  as 
consulting  psychologist.  In  September,  1913,  Dr.  V.  V. 
Anderson  was  appointed  assistant  probation  officer  of  the 
municipal  criminal  court  in  Boston,  for  the  pui-pose  of 
making  psychological  and  medical  examinations  of  crimi- 
nal offenders.  Various  charitable  agencies  in  many  cities 
are  now  attempting  to  supply  the  faciUties  for  the  psycho- 
logical, medical  and  sociological  examination  of  juvenile 
court  cases  {e.g.,  according  to  report.  New  York,  Newark, 
Baltimore,  Minneapolis,  Washington,  Cleveland)  ;  but  the 
psychological  examinations  are  often  made  by  amateurs 
or  by  physicians  with  little  or  no  technical  training  in 
psychological  diagnosis,  or  by  psychiatrists  with  a  distinct 
psychiatric  rather  than  psychological  and  educational 
bias. 

Let  me,  in  passing,  express  the  conviction,  however,  that 
the  problem  of  the  juvenile  dehnquent  is  less  the  problem 
of  the  juvenile  court  than  the  problem  of  the  public  schools. 


76      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Instead  of  haling,  a  la  wholesale,  incipient  or  active  child 
delinquents  into  court,  only  to  parole  the  large  majority 
of  them — a  procedure  little  calculated  to  impress  the 
youthful  offender  with  the  gravity  of  his  possible  perver- 
sity, or  with  the  respect  due  the  legal  statutes  of  the  com- 
munity, or  with  the  dignity  and  importance  of  court  pro- 
cedure, and  which  in  all  events  imposes  a  heavy  tax  on  the 
community  for  the  support  of  elaborate  court  machinery — 
all  possible  effort  should  be  made  to  keep  the  young  de- 
linquents out  of  court  altogether.  This  can  most  success- 
fully be  done  by  so  organizing  our  schools  that  they  will 
minister  educationally  to  the  peculiar  needs  of  mentally 
and  morally  exceptional  children.  It  is  the  public  schools 
rather  than  the  juvenile  courts  that  should  maintain  in 
their  educational  divisions  laboratories  for  the  study  and 
diagnosis  of  subnormal  and  delinquent  children.  Just  as 
soon  as  the  child  manifests  evidences  of  subnormality,  or 
tendencies  toward  incorrigibility  and  truancy — according 
to  A.  J.  Pillsbury,  90  per  cent  of  criminals  began  their 
criminalistic  careers  as  truants  in  the  schools — he  should 
be  examined  in  the  psycho-educational  clinic  of  the  schools, 
which  should  also  afford  a  medical,  hereditary  and  socio- 
logical examination.  As  a  result  of  the  examination  the 
child  should  be  provided  with  appropriate  physical  treat- 
ment, if  such  is  indicated ;  he  should  be  correctly  classified 
psychologically  and  educationally,  and  he  should  be  placed 
in  the  type  of  class  which  can  provide  the  educational 
training  which  he  requires.  With  a  proper  adjustment  of 
the  course  of  study  to  meet  the  needs  of  the  individual 
delinquent  the  problem  of  juvenile  delinquency  largely 
solves  itself.  If  you  give  abnormal  children  the  kind  of 
school  work  that  they  can  do  and  that  they  hke  to  do,  and 
place  them  in  a  school  environment  that  they  enjoy,  you 


NEW  CLINICAL  PSYCHOLOGY  77 

will  supply  the  most  efficient  and  humane  system  of  correc- 
tives for  juvenile  truancy  and  delinquency. 

Very  suggestive  in  this  connection  is  the  experience  of 
Los  Angeles  (Psychological  Clinic,  1913,  p.  84).  In  the 
public  schools  of  this  city  special  classes  for  persistent 
truants  (boys)  were  started  in  1905,  dedicated  to  the 
proposition  that  no  pupil  shall  fail  or  be  suspended  or 
expelled.  In  these  classes  the  boys  were  provided  with 
adaptable  men  teachers  and  with  curricula  more  closely 
related  to  the  life  interests  of  boys.  The  boys  were  given 
the  type  of  school  work  which  appealed  to  their  interests, 
and  was  adapted  to  their  varying  capacities.  In  1912 
there  were  nine  of  these  classes.  Among  the  notable 
results  of  this  experiment  are  the  following : 

(1)  No  boy  was  ever  suspended  or  expelled  from  the 
special  classes :  the  habit  of  suspending  and  expelling  boys 
from  the  public  schools  practically  ceased. 

(2)  The  average  attendance  in  these  classes  for  a 
period  of  seven  years  was  99  per  cent:  the  fit  school 
environment  practically  solved  the  non-attendance  and 
truancy  problems. 

(3)  The  truancy  work  of  the  juvenile  court  was  prac- 
tically abolished:  before  the  classes  were  organized  all 
persistent  truants  were  arrested  and  haled  before  the 
court.  In  1905-1906  there  were  fifty-six  of  these  cases ; 
in  1906-1907,  thirty ;  after  that,  never  more  than  three  a 
year,  and  one  year  none  at  all.  Now  the  schools  handle 
the  truants,  and  more  economically  and  efficiently. 

I  repeat:  the  problem  of  the  juvenile  delinquent  is  pri- 
marily a  problem  for  the  schools — first,  a  problem  of 
scientific  diagnosis  and,  second,  a  problem  of  supplying  a 
fit  school  environment.  Juvenile  courts  should  be  courts 
of  last  appeal — for  the  persistently  refractory  cases  and 


78      MENTAL  HEALTH  OF  SCHOOL  CHILD 

for  cases  which  cannot  be  brought  under  the  compulsory 
education  laws. 

5.  The  psychological  laboratory  in  penal  institutions 
and  correctional  homes.  Psychological  tests  (usually  only 
the  Binet  and  other  simple  tests  by  amateur  psychologists) 
are  now  being  given  as  a  matter  of  daily  routine  to  the 
boys  and  girls  in  a  considerable  number  of  reformatories 
and  correctional  institutions  throughout  the  country. 

Examinations  have  been  made  since  1908  of  the  inmates 
(whose  average  age  is  20.5  years)  in  the  Massachusetts 
Reformatory  for  Boys  at  Concord,  in  order  to  determine 
their  mental  and  moral  status.  These  examinations  have 
been  made  by  Guy  G.  Femald,  M.D.  Physical  tests  are 
also  employed  for  the  purpose  of  selecting  and  segregating 
mental  defectives. 

The  most  notable  research  institute  in  a  correctional 
institution  is  the  Laboratory  of  Social  Hygiene  in  the 
New  York  State  Reformatory  for  Women  at  Bedford 
Hills,  occupying  a  ten-room  building,  equipped  at  a  cost 
of  $250,000  for  the  study  of  the  causative  factors  and  the 
best  methods  of  training  female  (social)  delinquents.  The 
work  in  this  laboratory  began  in  July,  1911,  under  a 
$1,500  grant  from  the  New  York  Foundation,  but  is  now 
fostered  by  the  New  York  Bureau  of  Social  Hygiene.  The 
director  of  psychological  research  and  field  work  is  Jean 
Weidensall,  Ph.D.  The  staff  will  include  a  psychopatholo- 
gist,  sociologist  and  educationist. 

The  Indiana  Reformatory,  Jeffersonville,  organized  a 
department  of  research  August  12,  1912,  with  Prof. 
Rufus  B.  von  Klein  Smid  as  director,  F.  C.  Paschal  and 
W.  Beanblossom  as  assistants  in  psychology,  R.  W. 
Merrifield  as  assistant  in  social  research  and  J.  M.  Walker, 
M.D.,   as   consulting  physician   and   assistant   in  medical 


NEW  CLINICAL  PSYCHOLOGY  79 

research.  The  cost  of  the  psychological  equipment  to 
date  amounts  to  about  $500.  The  department  administers 
the  problem  of  the  discipline  of  the  inmates,  and  controls 
the  disposition  of  their  time  {i.e.,  it  determines  the  char- 
acter of  the  work  suitable  to  each  case,  the  character  of 
the  schooling  to  be  given  different  boys  and  the  transfer 
of  cases  to  other  state  institutions  in  which  they  more 
properly  belong). 

Among  the  institutions  which  have  more  recently  estab- 
lished departments  of  psychological  investigation  are  the 
following:  Girls'  Industrial  Home,  Sleighton  Farm,  Dar- 
lington, Pa.  (Miss  Helen  F.  Hill  in  charge  since  1913), 
and  the  State  Home  for  Girls  at  Trenton,  N.  J.  (Mar- 
garet Otis,  Ph.D.,  resident  psychologist).  Psychological 
examinations  are  also  conducted  in  the  Massachusetts 
Reformatory  for  Women  at  South  Framingham.  In 
April,  1912,  the  New  York  Probation  and  Protective 
Association  appointed  Frederick  Ellis,  Ph.D.,  to  conduct 
psychological  studies  of  the  socially  dehnquent  girls  who 
are  in  the  care  of  the  association. 

Mention  may  also  be  made  at  this  point  of  the  fact  that 
several  states  (thus  New  Jersey  and  Minnesota)  have 
within  the  last  two  or  three  years  made  definite  legislative 
appropriation  for  the  study  of  the  heredity  and  psychol- 
ogy of  their  mentally  and  morally  abnormal  dependents 
and  delinquents. 

The  time  is  near  at  hand  when  our  criminals  and  delin- 
quents, juvenile  or  adult,  whether  in  juvenile  courts,  jails, 
prisons,  reformatories,  houses  of  rescue  or  detention 
homes,  will  be  given  individual  study  from  the  points  of 
view  of  anthropology,  medicine,  sociology  and  of  clinical 
and  criminal  psychology.  Not  only  so,  the  time  must  come 
when  the  truthfulness  of  testimony  and  the  veracity  of 


r 


80      MENTAL  HEALTH  OF  SCHOOL  CHILD 

witnesses  will  be  tested  by  methods  other  than  the  crude 
method  of  cross-examination  (23).  The  laboratory 
method  of  determining  capacity  for  correctness  of  descrip- 
tion and  report  will  prove  an  aid  to  the  jurist.  Psychol- 
ogy is  destined  to  contribute  something  toward  making 
criminology  and  jurisprudence  more  scientific.  When  the 
methods  of  science  have  been  applied  to  the  study  of  the 
delinquent  and  criminal,  we  shall  be  in  a  position  to  adapt 
the  penalty,  qualitatively  as  well  as  quantitatively,  to  the 
nature  of  the  offender  rather  than  to  the  nature  of  the 
offense.  Frequently  the  roots  of  criminality  lie  embedded 
in  a  criminal  neuropathic  heredity,  or  in  certain  irresistible 
habits  which  have  been  engendered  by  vicious  or  criminal 
influences  in  the  social  environment,  in  a  diseased  or  physi- 
cally malformed  organism  which  thereby  has  become  func- 
tionally maladapted  to  its  physical  and  psychical  environ- 
ment, or  in  mental  deficiency.  The  role  of  the  different 
causal  factors  must  be  rightly  estimated  for  every  indi- 
vidual offender  before  we  can  deal  scientifically  with  the 
problems  of  crime  and  criminology.  Our  methods  of  crim- 
inal procedure  have  too  long  been  on  a  par  with  that 
type  of  cure  which  treats  effects  but  ignores  causes.  The 
Binet-Simon  and  other  psychological  tests  will  aid  the 
alienist  and  jurist  in  determining  the  mental  status  and 
responsibility  of  persons  in  commitment.  The  arrest, 
deviation  or  degeneration  revealed  by  such  tests  will  often 
be  found  to  affect  precisely  those  higher  psychical  powers 
without  whose  integrity  of  function  the  individual  cannot 
attain  that  standard  of  conformity  to  law  demanded  by  his 
social  environment.  It  will  frequently  be  found  that  the 
arrest  or  atrophy  of  various  mental  processes  may  be  so 
serious  as  to  produce  permanent  mental  and  moral 
maladjustment    to    the    community    ethical    requirements. 


NEW  CLINICAL  PSYCHOLOGY  81 

Offenses  by  such  individuals  may  be  without  conscious 
criminal  intent.  There  is  no  immorality  of  intent  in  their 
criminal  actions,  though  there  is  immorality  of  act.  Such 
individuals  are,  subjectively  considered,  unmoral,  like  the 
infant,,  who  cannot  appreciate  the  distinction  between  right 
and  wrong.  Their  immorality  and  criminality  are  resolv- 
able into  mental  deficiency.  None  the  less,  these  persons 
are  a  menace  to  society,  and  require  permanent  restraint 
as  a  protective,  rather  than  a  punitive,  measure. 

6.  The  psycho-educational  clinic  in  relation  to  voca- 
tional guidance.  There  are  six  essential  functions  of  a 
vocational  bureau. 

First,  the  maintenance  of  a  free  placement  agency. 
This  is  the  function  apparently  exalted  above  all  others  by 
the  existing  bureaus. 

Second,  the  making  of  a  local  vocational  or  industrial 
survey.  Tliis  survey  should  include  a  tabulation  of  all  the 
establishments  of  the  community  which  afford  employment 
to  youthful  wage-earners ;  an  appraisal  of  the  moral, 
hygienic,  sanitary  and  labor  conditions  surrounding  each 
plant  or  type  of  industry;  a  determination  of  the  initial 
and  prospective  ultimate  financial  returns  yielded  by  dif- 
ferent occupations ;  a  determination  of  the  chances  for 
promotion  together  with  the  probable  rate  of  advance- 
ment, and  the  prompt  listing  of  positions  as  they  become 
available. 

Third,  the  ascertainment  of  the  physical  health  index 
and  the  salient  anthropological  indices  of  the  applicants. 
It  is  unscientific  and  pernicious  to  place  pupils  in  lines  of 
employment  for  which  they  are  unfitted  by  virtue  of  specific 
constitutional  or  acquired  diatheses,  diseases  or  defects, 
such  as  tubercular  predisposition,  gouty  or  rheumatic 
diatheses,  neuropathic  heredity,  nasopharyngeal  disorders, 


82      MENTAL  HEALTH  OF  SCHOOL  CHILD 

certain  auditory,  visual  or  olfactory  defects,  or  palsies  or 
deformities  of  certain  bodily  members.  How  many  of  the 
existing  so-called  guidance  bureaus  pay  any  consideration 
to  the  vital  factor  of  bodily  efficiency?  Many  of  the 
directors  of  these  bureaus  have  no  technical  knowledge  of 
the  physiological  factors  concerned,  and  apparently  many 
do  not  seek  to  obtain  tliis  knowledge. 

Fourth,  the  ascertainment  of  the  individual  vocational 
preferences,  proclivities  or  inclinations  of  the  applicants. 
'Vocational  guidance'  which  directs  children  into  lines  of 
employment  for  which  they  have  no  taste  and  in  which  they 
lack  all  interest  is  not  only  a  misnomer,  but  it  is  culpable, 
inexcusable,  blundering  empiricism.  Most  children,  pro- 
vided they  possess  the  requisite  psychomotor  capacity,  will 
succeed  in  any  line  of  work  in  wliich  they  manifest  a  keen 
healthy  interest.  They  will  just  as  surely  fail,  or  achieve 
an  indifferent  success,  if  they  are  placed  in  uninteresting, 
disagreeable  occupations.  Success  in  life  work  usually 
turns  on  hitching  the  right  job  to  the  right  interest.  How 
many  existing  bureaus  make  any  effort  to  ascertain  the 
real  inclinations  of  the  apphcants  beyond  asking  a  few 
perfunctory  questions.'*  How  many  make  any  effort  to 
secure  the  independent  judgment  of  the  observant  teacher 
or  parent  or  the  psychological  specialist.'' 

Fifth,  the  determination  of  the  general  functional  level 
of  capacity  or  achievement — the  mental  or  moto-industrial 
age — of  the  applicants.  It  is  worse  than  folly  to  'guide' 
children  into  vocations  to  whose  efficiency  demands  they 
cannot  adjust  themselves  because  of  all-round  lack  of 
mental  or  motor  capacity.  Many  of  the  adolescent  break- 
downs and  adult  neuroses  and  psychoneuroses  are  due  to 
the  inability  of  the  persons  to  meet  the  exacting  require- 
ments of  the  vocations  in  which  they  happen  to  find  them- 


NEW  CLINICAL  PSYCHOLOGY  83 

selves.  To  place  a  child  with  a  nine-year  mentality  in  a 
position  which  requires  a  fourteen-year  mentality  is  to 
condemn  him  to  repeated  failure,  perennial  job-hunting 
and  ultimate  dependency,  delinquency  or  mental  and 
nervous  collapse.  Many  children  seeking  the  aid  of  the 
bureaus  will  rank  in  capacity  with  the  pupils  who  are  now 
in  up-to-date  schools  placed  in  the  special  classes  for 
morons,  border-line  and  backward  cases.  We  know  that 
most  of  these  children  will  not  be  able  to  support  themselves 
in  trades  which  require  any  considerable  degree  of  technical 
skill  or  endurance.  Without  attempting  to  review  all  the 
available  data  as  to  the  industrial  inefficiency  of  the  gradu- 
ates of  the  special  classes  of  the  public  schools,  I  may  state 
that  the  'Royal  Commission  on  the  Care  and  Control  of  the 
Feeble-minded'  concluded  that  47  per  cent  of  the  pupils 
from  the  special  classes  of  the  London  schools  will  never 
be  able  to  earn  their  own  living,  28  per  cent  probably  will 
do  so  under  proper  direction,  while  only  22  per  cent  may 
be  regarded  as  'possible  wage-earners.'  The  'After  Care 
Committee  of  Birmingham'  followed  up  the  careers  of  650 
graduates  from  the  special  classes  of  the  city  schools 
during  nine  years  and  found  that  only  18  per  cent  were 
doing  remunerative  work  (at  an  average  weekly  wage  of 
6s.  Id.)  ;  a  later  statement  (School  Hygiene,  February, 
1913,  p.  7)  indicates  that  42  per  cent  of  those  reported 
were  employed.  Because  the  children  were  unable  to  retain 
their  jobs,  particularly  as  they  grew  older,  the  committee 
abandoned  the  free  employment  bureau  which  it  conducted 
for  four  years.  In  Liverpool  only  28  per  cent  were  em- 
ployed, in  Leeds  45  per  cent  were  found  in  'good  promising 
or  fair  employment,'  while  the  combined  statistics  in  1908 
from  nine  English  cities  showed  that  only  22  per  cent  were 
at  work  and  6.8  per  cent  were  in  irregular  work.     Of  fifty 


84      MENTAL  HEALTH  OF  SCHOOL  CHILD 

cases  selected  at  random  from  the  'ungraded  classes'  in 
the  New  York  City  schools  only  4  per  cent  held  permanent 
positions,  10  per  cent  had  'worked  steadily  for  a  few  weeks 
at  an  average  of  $3.50  per  week,'  and  the  majority  were 
'utterly  incapable.'  Of  ten  graduates  of  the  subnormal 
classes  in  the  Cliicago  schools  who  were  investigated  three 
were  wholly  unfit  for  responsible  positions,  and  the  average 
weekly  wage  of  the  others  was  only  $5.73.  In  Germany  the 
record  is  better — 70  to  80  per  cent  of  the  auxiliary  pupils 
can  earn  their  living,  according  to  Bottger — but  that  is 
largely  because  the  pupils  are  placed  in  the  type  of  work 
that  they  can  do,  and  are  given  supervision  by  guardians 
and  by  masters-of-trade,  under  whom  many  of  them  labor. 

Recently  it  was  my  fortune — or  misfortune — to  witness 
a  director  of  a  public  school  bureau  of  vocational  guidance 
'guide'  a  boy  of  fourteen  into  a  line  of  work  in  which  he 
must  certainly  fail.  It  would  have  been  quite  evident  to 
a  psycho-clinical  specialist  from  a  cursory  examination 
that  the  boy  was  a  microcephaUc  moron!  Was  it  not 
essential  for  purposes  of  scientific  guidance  that  this 
director  should  have  known  that  he  was  negotiating  with 
a  feeble-minded  boy  who  presumptively  cannot  stand  the 
strain  of  skilled  factory  employment  under  the  conditions 
of  modern  competitive  industrialsm .''  What  justification  is 
there  for  calling  this  a  guidance  bureau  when  it  makes  no 
attempt  to  call  in  the  consulting  psychologist  to  determine 
the  general  level  of  functioning  of  at  least  the  obviously 
abnormal  cases  .'^  It  is  very  clear  to  me  that  employers 
will  not  continue  to  go  to  school  vocational  bureaus  for 
applicants  whose  powers  and  capacities  the  bureaus  have 
made  no  scientific  attempt  to  evaluate. 

The  present  nation-wide  interest  in  the  establishment 
of  bureaus  of  vocational  eruidance  is  commendable.     But 


NEW  CLINICAL  PSYCHOLOGY  85 

let  us  not  forget  that  many  if  not  most  of  the  existing 
bureaus  are  unconscious  of  any  obhgation  to  the  com- 
munity except  that  of  making  vocational  surveys  and  list- 
ing and  finding  jobs  for  work-certificate  pupils.  They 
are  merely  free  employment  agencies.  They  fall  far  short 
of  their  highest  function,  namely,  expert  scientific  guid- 
ance. It  would  seem  to  be  more  rational  and  profitable  to 
establish  the  bureaus  as  a  division  of  the  department  of 
psycho-educational  diagnosis,  than  as  independent  depart- 
ments in  the  public  schools,  so  that  at  least  the  more 
obvious  cases  may  be  given  a  psychological  examination 
(not  to  mention  the  anthropometric  and  medical)  to  deter- 
mine their  general  mental  status.  This  should  be  done 
before  any  attempt  is  made  to  direct  them  into  a  vocation. 
To  repeat :  vocational  guidance  should  include  more  than 
making  industrial  surveys:  it  should  include  the  making  of 
human  surveys,  that  is,  surveys  of  the  mental  (and  physi- 
cal) status  of  the  applicants  themselves.  Only  thus  shall 
we  be  able  to  find  the  right  man  for  the  right  job  and  the 
right  job  for  the  right  man. 

Sixth,  the  determination  of  the  specific  motor,  mental 
or  industrial  gifts  or  deficiencies  of  each  applicant.  Suc- 
cessful workers  in  specific  trades,  handicrafts  and  occupa- 
tions must  possess  a  certain  minimal  amount  of  the  specific 
traits  or  talents,  or  combinations  of  traits,  demanded  by 
the  occupations  in  question.  Those  who  possess  in  maximal 
degree  the  required  traits  constitute  the  preferred  or 
talented  class  of  workers.  It  is  evident,  for  example,  that 
successful  typewritists  must  possess  a  high  degree  of 
psychomotor  rapidity  and  accuracy ;  successful  motor  men 
require,  for  certain  of  their  duties,  a  high  degree  of  rapid- 
ity, accuracy  and  range  of  observation,  of  celerity  of 
response  and  of  presence  of  mind.     It  is  possible  experi- 


86      MENTAL  HEALTH  OF  SCHOOL  CHILD 

mentally  to  determine  what  mental  capacities  are  required 
by  successful  telephone  operators,  ticket  sellers,  paper 
wrappers,  railroad  engineers,  or  any  operative  engaged  in 
any  line  of  skilled  work  whatsoever,  and  it  is  also  possible 
to  deteiTnine  to  some  extent  by  psychological  tests  whether 
a  given  apphcant  for  a  job  possesses  the  qualifications 
required  by  that  job  (25).  However,  we  are  better  able 
with  our  existing  diagnostic  refinements  to  determine  an 
individual's  all-round  grade  of  mental  development  than 
his  specific  vocational  'longs'  or  'shorts.' 

Mention  should  be  made  in  this  connection  of  the  study 
made  of  children  who  go  into  industry  by  the  Schmidlapp 
Bureau  and  a  number  of  private  contributors,  in  Cincin- 
nati. The  investigation  includes  a  study  of  the  effects  of 
industrial  work  upon  the  physical  and  mental  development 
of  fourteen-year-old  work-certificate  children  (comparative 
physical  and  mental  measurements  are  made  of  fourteen- 
year-old  children  who  remain  in  school),  a  study  of  the 
children  who  fail  in  industry  (including  a  comparison  of 
their  performances  in  psychological  tests),  the  establish- 
ment of  age-norms  for  various  psychological  tests,  and  a 
study  of  the  children's  earnings,  pay  increases  and  amount 
of  unemployment.  The  scientific  work  is  directed  by  Helen 
T.  Woolley,  Ph.D.  So  far  as  I  have  been  able  to  gather 
information  no  examinations  have  been  made  with  a  view 
to  determining  the  general  functional  level  or  specific 
capacities  of  the  applicants  for  clinical  purposes,  hence 
the  bureau  cannot  be  classed  as  a  psychological  clinic,  as 
some  writers  have  done. 

7.  The  psychological  clinic  vn  the  immigrant  station. 
At  the  fifteenth  International  Congress  on  Hygiene  and 
Demography  held  in  Washington  in  September,  1912,  I 


NEW  CLINICAL  PSYCHOLOGY  87 

took  occasion  to  comment  substantially  as  follows,  at  one 
of  the  sessions  of  the  subsection  on  mental  hygiene : 

'Recently  an  attempt  was  made  to  induce  Congress  to 
enact  a  law  excluding  immigrants  on  the  basis  of  tests  of 
information  or  literacy.  The  bill  passed  by  Congress 
deserved  to  be  vetoed,  because,  in  my  opinion,  it  failed 
utterly  to  meet  the  situation.  What  we  need  on  the  side 
of  diagnosis  for  detecting  mentally  defective  foreigners  is 
primarily  not  tests  of  information,  erudition,  literacy  or 
mere  acquisition,  but  tests  designed  to  determine  the 
strength  of  the  power  of  acquiring  information,  psycho- 
logical tests  of  the  inherent  strength  of  various  funda- 
mental mental  traits.  Illiteracy  and  mental  deficiency 
(feeble-mindedness)  are  not  synonymous  terms.  Many 
illiterates  come  to  our  shores  who  are  perfectly  normal  in 
mental  potentials,  who  are  capable  of  making  the  best 
citizens,  intellectually,  morally,  socially  and  industrially, 
and  who  should,  therefore,  not  be  deported.  Their  illiteracy 
is  due  to  lack  of  educational  opportunities  or  proper 
mental  training.  The  problem  is  to  distinguish  this  type 
of  illiteracy  from  the  type  that  is  due  to  mental  sub- 
normality.  Really  it  is  not  a  problem  of  literacy  or  illit- 
eracy as  such,  but  a  problem  of  capacity  and  incapacity. 
It  is  therefore  evident  that  what  we  want  are  not  chiefly 
tests  of  literacy,  but  tests  of  mental  capacity.  If  so,  the 
task  of  diagnosing  mentally  defective  or  feeble-minded 
foreigners  is  distinctly  a  psychological  problem,  and 
requires  the  services  of  an  expert  consulting  psychologist 
who  has  had  extensive  first-hand  experience  with  feeble- 
minded cases.  The  average  medical  immigration  inspector 
is  just  as  fully  "at  sea"  when  he  tries  to  identify  the  sub- 
normal immigrant  as  the  average  medical  school  inspector 
is  "at  sea"  when  he  tries  to  diagnose  the  various  types  of 


88      MENTAL  HEALTH  OF  SCHOOL  CHILD 

educationally  unusual  children  in  the  schools  and  prescribe 
appropriate  orthogenic  pedagogical  treatment  for  each 
case.  Neither  the  immigration  nor  the  school  medical 
inspectors  have  been  specifically  or  professionally  trained 
for  these  lines  of  highly  technical  and  difficult  work. 
Neither  type  of  inspector  would  be  able  adequately  to 
quahfy  for  this  branch  of  service  in  less  than  two  or  three 
full  years  of  technical  training — this  is  especially  true  of 
the  school  medical  inspector.  Moreover,  it  may  be  said 
that  the  stock  psycliiatric  methods  of  examination  have 
little  value  except  for  the  psychotic  cases.  The  specialist 
on  the  feeble-mindedness  of  immigrants  must  receive  a 
course  of  training  which  is  just  as  specific  and  technical  as 
that  received  by  the  specialist  on  the  eyes,  on  dental  sur- 
gery, on  metallurgical  engineering,  or  on  kindergarten 
teaching.' 

The  position  thus  taken  has  been  regarded  as  far- 
fetched, but  I  believe  it  is  essentially  sound.  Strong  con- 
firmatory evidence  that  this  is  so  is  afforded  by  an  experi- 
ment carried  out  during  the  course  of  one  week  at  the 
immigrant  station  at  Ellis  Island  by  the  psychological 
assistants  from  the  training  school  for  feeble-minded  chil- 
dren at  Vineland,  N.  J.,  the  results  of  which  have  since 
appeared  in  print  (Training  School,  1913,  p.  109).  The 
experiment  indicated  that  the  government  physicians  on 
duty  were  able  to  recognize  only  about  10  per  cent  of  a 
given  number  of  the  mental  defectives  passing  through 
the  port.  Moreover,  more  than  half  of  those  whom  they 
selected  were  incorrectly  chosen,  while  seven-eighths  of 
those  selected  by  the  Vineland  workers  were  properly 
identified,  as  determined  by  later  tests. 

Without  raising  the  question  as  to  the  absolute  relia- 
bility of  the  above  data,  there  is  no  doubt  that  our  immi- 


NEW  CLINICAL  PSYCHOLOGY  89 

grant  stations,  because  of  their  defective  and  inadequate 
examining  macliinery/  are  annually  permitting  many 
hundreds  of  morons  and  imbeciles  to  land  upon  our  shores. 
These  immigrants  will  eventually  become  public  charges 
and,  unless  restrained,  will  produce  a  prolific  progeny  of 
social  and  industrial  incompetents.  As  long  as  the  govern- 
ment allows  this  situation  to  continue,  little  headway  can 
be  made  in  the  effort  to  reduce  the  defective,  delinquent 
and  dependent  classes.  The  way  to  check  this  national  evil 
is  to  establish  psychological  clinics  in  the  immigrant  sta- 
tions, and  put  them  in  charge  of  thoroughly  trained 
experts — either  physicians  or  psychologists — who  must 
do  more  than  give  a  few  psychiatric,  literacy,  or  hap- 
hazard commonsense  psychological  tests.  They  must 
attempt  a  fairly  comprehensive  and  systematic  survey  of 
the  stage  of  mental  development  of  the  suspect. 

8.  The  psycho-educational  clinic  and  bureau  of  re- 
search in  the  public  schools.  Unquestionably  one  of  the 
most  fruitful  fields  for  the  application  of  clinical  psy- 
chology is  education.  Nowhere  are  the  practical  benefits  to 
be  derived  more  patent.  American  public  schools  have 
shown  commendable  enterprise  in  securing  increased  physi- 
cal comforts,  the  erection  of  costly  material  plants,  the 
equipment  of  expensive  laboratories  for  instruction,  the 
organization  of  new  courses  to  meet  the  enlarged  demands 
of  the  altered  social  and  industrial  conditions  of  the 
twentieth  century,  but  it  must  be  confessed,  to  our  shame, 
that  they  have  lagged  considerably  behind  the  institutions 

7  Two  questionnaires  were  addressed  to  the  chief  surgeon  of  one 
of  the  immigrant  stations,  with  the  expectation  that  definite,  unam- 
biguous information  would  be  obtained  regarding  the  character  of  the 
psychological  examinations  made  of  subnormal  immigrants,  but 
without  avail.  A  psychological  clinic,  however,  is  evidently  conducted 
at  the  Ellis  Island  station. 


'1 


90      MENTAL  HEALTH  OF  SCHOOL  CHILD 

for  the  abnormal  and  defective  in  respect  to  the  establish- 
ment of  laboratories  for  discovery  and  research.  So  far 
as  promoting  or  conducting  departments  for  the  scientific 
study  of  the  problems  which  concern  the  normal  health 
and  development  of  the  child's  body  and  mind,  the  condi- 
tions under  which  such  development  can  be  most  economi- 
cally secured,  the  questions  of  the  most  expeditious  learn- 
ing and  the  most  economic  teaching  methods,  of  fatigue, 
of  the  length  of  the  school  day  and  of  the  school  year,  of 
the  scientific  examination,  and  classification,  segregation 
and  treatment  of  the  retarded,  accelerated  and  delinquent, 
they  have  until  recently  done  practically  nothing.  The 
one  outstanding  exception  is  the  public  schools  of  Chicago, 
in  which  a  department  of  child  study  and  pedagogic  inves- 
tigation was  established  in  1899  (20).  This  department, 
which  now  commands  the  services  of  D.  P.  MacMillan, 
Ph.D.  (director),  F.  G.  Bruner,  Ph.D.,  and  Miss  Clara 
Schmitt,  has,  since  its  organization,  made  various  studies 
of  educationally  normal  and  misfit  children — the  blind, 
deaf,  truant,  retarded,  feeble-minded,  etc. — has  regularly 
examined  candidates  for  admission  to  the  city  normal 
school  and  has  issued  a  series  of  valuable  annual  reports 
embodying  its  findings. 

During  the  last  few  years  there  has  come  a  radical  and 
gratifying  change  of  attitude  on  the  part  of  educational 
experts  toward  the  exceptional  child — the  subnormal 
(idiot,  imbecile,  moron,  border-line,  backward  and  dull), 
the  supernormal  (bright,  gifted,  talented,  precocious), 
the  cripple,  epileptic,  speech-defective,  blind,  deaf  and 
mute.  It  is  now  recognized  by  the  intelligent  public 
everywhere  that  the  mentally  deviating  child  sets  a  special 
problem.  On  a  conservative  estimate  from  2  to  4  per  cent 
of  the  retarded  children  in  the  schools  are  idiots,  imbeciles, 


NEW  CLINICAL  PSYCHOLOGY  91 

morons,  border-cases,  epileptics  and  pronounced  neurotics 
and  psycho-neurotics.  From  15  to  30  per  cent  grade  all 
the  way  from  the  border-line  or  seriously  backward  cases 
to  the  merely  dull  or  slow-progress  pupils.  Fully  one- 
third  (in  many  systems  one-half)  of  the  public  school 
children  are  pedagogically  retarded  when  measured  by  the 
age-grade  standard  (approximately  6,000,000  pupils  in 
the  United  States).  About  2  per  cent  suffer  from  some 
form  of  speech  defect.  There  is  no  more  vital  problem  in 
educational  administration,  constructive  philanthropy  or 
race  conservation  than  the  organization  of  intelligent 
preventive,  reconstructive,  educational  and  reeducational 
work  for  the  large  army  of  mentally  deviating  children 
which  encumber  our  schools.  To  neglect  properly  to  care 
for  these  children  would  be  to  invite  national  disaster. 
The  only  effective  method  of  dealing  with  defective  chil- 
dren is  to  segregate  them  into  special  groups  and  to  pro- 
vide special  treatment,  care,  training  or  restraint.  Not 
only  will  this  policy  tend  to  remove  dead  weights  and  irri- 
tating impediments  from  the  regular  classes,  so  that  the 
typical,  hopeful,  progressive  children  may  receive  their 
just  dues,  but  in  the  long  run  it  will  prove  the  only  way  in 
which  the  mentally  handicapped  child  can  be  saved  to 
society  from  a  life  of  idleness,  pauperism  or  crime.  He  can 
be  saved  only  by  being  sufficiently  prepared  to  discharge 
the  industrial  and  social  responsibilities  of  citizenship  or, 
in  cases  where  special  training  proves  unavailing  because 
of  grave  permanent  arrest  or  defectiveness,  by  being  iso- 
lated from  society  in  custodial  institutions.  Let  us  not 
forget  that  the  first  step  in  the  successful  solution  of  this 
vital  school  problem  is  the  early  selection  of  the  abnormal 
children  in  the  schools  by  the  qualified  psycho-educational 
examiner. 


92      MENTAL  HEALTH  OF  SCHOOL  CHILD 

Owing  to  the  combined  influences  of  the  laboratories  of 
the  Chicago  schools,  the  University  of  Pennsylvania  and 
Vineland,  psychological  tests  are  now  being  carried  out  in 
many  public  school  systems  throughout  the  country.  In 
order  to  obtain  accurate  data  in  regard  to  the  character 
of  the  work  done  in  psychological  diagnosis,  as  well  as  the 
educational  provisions  made  for  mentally  unusual  children 
in  the  public  schools,  a  questionnaire  was  addressed  October 
29,  1913,  to  the  superintendents  of  public  schools  in  the 
United  States.  The  returns  will  be  given  in  Chapter 
XVIII. 

At  this  point  reference  may  appropriately  be  made  to 
the  state  law  enacted  in  California  in  1908,  authorizing 
the  establishment  of  departments  of  'health  and  develop- 
ment supervision'  in  the  public  schools  under  the  control  of 
boards  of  education  or  of  school  trustees.  The  program  of 
work  contemplates  the  annual  physical  examination  of 
pupils  and  a  'follow-up'  ser\uce,  in  order  to  correct  physi- 
cal abnormalities  and  to  provide  the  conditions  essential 
for  the  maintenance  of  continuous  health  and  normal 
growth;  the  adjustment  of  school  activities  to  meet  the 
developmental  needs  of  the  individual  in  respect  to  health 
and  growth;  the  scientific,  systematic  study  of  mental 
retardation  and  deviation;  proper  sanitary  supervision; 
the  physical  examination  of  candidates  for  teaching  posi- 
tions and  of  teachers  in  service  to  determine  their  vital 
fitness  and  the  amount  of  work  which  may  reasonably  be 
required  of  them  without  imperiling  efliciency,  and  the 
appointment  of  expert  educator-examiners  to  conduct  and 
supervise  the  work.  These  examiners  must  qualify  as 
experts  in  child  hygiene  and  physiology.  Above  all,  they 
should,  in  my  judgment,  be  trained  in  the  methods  of 
clinical  psychology  and  educational  diagnosis.     The  pro- 


NEW  CLINICAL  PSYCHOLOGY  93 

jected  California  work  thus  rests  upon  a  far  broader 
basis  than  the  system  of  medical  inspection  now  in  vogue, 
and  will  make  it  possible  to  grade  children  in  health  as 
well  as  in  studies.     The  law  is  not  mandatory. 

Under  this  law  quite  a  number  of  school  systems  in  Cali- 
fornia have  established  departments  of  health  and  develop- 
ment supervision  (although  the  work  done  is  probably 
largely  restricted  to  the  ordinary  medical  inspection  rou- 
tine). But  it  is  interesting  to  note  that  two  of  the  most 
progressive  school  systems  of  the  state  have  estabhshed 
psychological  clinics  independently  of  the  department  of 
health  and  development  supervision,  namely  Los  Angeles 
(with  Mr.  George  L.  Leslie,  who  was  responsible  for  the 
'health  and  development  law,'  as  director)  and  Oakland 
(Mrs.  Vinnie  C.  Hicks,  director).  While  theoretically  it 
would  seem  desirable  to  locate  the  psychological  clinic  in 
the  department  of  health  and  development  supervision, 
practically  it  may  be  better  to  conduct  the  psycho-educa- 
tional examinations  in  a  separate  department  of  the 
schools,  in  order  that  the  work  may  not  be  identified  with 
the  usual  routine  of  medical  inspection,  in  order  that  it 
may  not  be  unduly  hampered  by  the  red  tape  which 
attaches  to  large  departmental  organizations,  and  in  order 
that  this  important  work  may  not  be  assigned  a  wholly 
minor  role  in  a  department  whose  primary  interests  may 
be  quite  foreign  to  the  pedagogico-corrective  treatment 
of  mentally  unusual  children. 

The  Possibilities  of  a  Bureau  of  School  Research 

In  view  of  the  fact  that  the  intelligent  educational 
public  is  gradually  becoming  reconciled  to  the  proposition 
that  the  changed  industrial  and  social  conditions  of  modern 
life   necessitate   the   organization   of   various   new   school 


94      MENTAL  HEALTH  OF  SCHOOL  CHILD 

agencies — departments  of  medical  and  dental  inspection, 
of  school  hygiene,  of  experimental  pedagogy,  of  social 
survey  work,  of  psycho-educational  laboratories  for  the 
examination  of  exceptional  children — I  wish  to  pause  a 
moment  to  outline  briefly  the  work  which  a  bureau  of  school 
research  might  profitably  undertake  for  the  good  of  the 
schools. 

At  the  outset  it  should  be  said  that  the  results  of  the 
various  agencies  which  are  being  organized  in  the  schools 
for  purposes  of  educational  investigation  and  diagnosis 
are  liable  to  run  to  sand  unless  they  are  properly  unified, 
correlated  and  brought  to  a  focus.  There  is  need,  there- 
fore, of  a  central,  unifying  bureau  or  department  of 
school  research,  in  charge  of  a  director  of  school  research, 
where  the  data  collected  by  the  various  examining  agencies 
may  be  gathered,  preserved,  compiled,  compared,  corre- 
lated, interpreted  and  turned  to  practical  use. 

The  director  of  such  a  bureau  should  be  an  expert  in 
child,  educational  and  cHnical  psychology,  who  has  done 
productive  work  of  recognized  merit  in  these  fields.  He 
should  be  thoroughly  familiar  with  the  methods  employed 
by  these  sciences  and  by  experimental  pedagogy,  and 
should  have  some  knowledge  of  medical  inspection  work 
(a  minimum  of  knowledge  in  regard  to  physical  diagnosis 
and  the  signs  and  symptoms  of  physical  defectiveness  and 
nervous  instability).  He  should  be  a  technical  education- 
ist, with  practical  teaching  experience,  preferably  in 
public  and  teacher-training  schools,  and  must  possess  the 
ability  to  plan  and  direct  the  work  along  broad,  progres- 
sive lines.  His  should  be  distinctly  a  position  of  leadership 
in  the  educational  work  of  the  schools,  ranking  as  a  direc- 
torship or  assistant  superintendency,  and  nothing  but  a 
thoroughly  trained,  broad-gauge,  technical,  psycho-edu- 


NEW  CLINICAL  PSYCHOLOGY  95 

cational  consultant  should  be  able  to  qualify.  (Paren- 
thetically let  me  say  that  since  the  above  was  first  written, 
bureaus  of  statistics,  reference  or  research  have  been  estab- 
lished in  the  public  schools  of  New  Orleans,  Rochester, 
Baltimore  and  New  York  City.  Cleveland  also  maintains  a 
statistician.  While  these  bureaus  have  other  functions 
than  those  given  below,  the  program  of  work  in  some  of 
them  includes  statistical  and  clinical  studies  of  retardation 
and  the  giving  of  efficiency  tests.) 

The  materials  to  be  collected  and  correlated  by  our 
bureau  should  be  derived  from  the  following  sources : 

1.  Records  and  charts  of  physical  (medical  and 
dental)  examinations  and  treatment — nasopharyngeal  and 
dental  charts,  showing  the  locations  of  nose  and  throat 
obstructions  and  defective  dentures ;  vaccination  records 
and  charts,  showing  the  dates  of  inoculation  and  the  num- 
ber of  vaccine  scars ;  abnormalities  of  the  respiratory,  cir- 
culatory, nutritive,  muscular,  osseous  and  nervous  systems ; 
sensory  defects  (visual,  auditory)  ;  records  of  operations 
and  of  medical  and  dental  treatment,  with  the  carefully 
determined  results  of  such  treatment,  etc.  The  data  should 
be  recorded  annually,  if  possible,  on  duplicate  cards,  which 
should  accompany  the  child  from  grade  to  grade.  The 
originals  should  be  filed  in  the  bureau  of  records. 

It  would  lead  the  discussion  too  far  afield  to  consider 
what  should  be  the  detailed  functions  and  relations  of  the 
department  of  physical  or  medico-dental  examination.  The 
matters  in  dispute  revolve  around  the  questions  whether 
the  work  should  be  entirely  confined  to  examination,  or 
whether  it  should  include  free  treatment,  at  least  for  the 
minor  ailments  (22)  ;  whether  the  system  should  be  under 
the  control  of  boards  of  health  or  of  school  boards  ;  whether 
inspection  should  be  supplemented  by  follow-up  educational 


96      MENTAL  HEALTH  OF  SCHOOL  CHILD 

care,  treatment  and  supervisory  work  by  a  corps  of  school 
nurses,  both  in  and  out  of  school;  whether  it  should  em- 
brace the  sanitary  inspection  and  supervision  of  the 
school  plant ;  whether  it  should  include  instruction  and 
supervision  in  individual  and  school  hygiene ;  whether  it 
should  include  provision  for,  and  supervision  of,  school 
lunches,  gratuitously  available  to  indigent  anemics,  for 
school  baths,  gymnasia,  etc.  These  questions  cannot  be 
answered  in  the  abstract ;  in  the  near  future  they  will 
loom  large  in  the  educational  discussion  of  the  day.  They 
constitute  one  phase  of  the  large  eugenics  or  euthenics 
movement  which  has  recently  been  forced  into  the  focus 
of  public  attention  by  the  threatened  dangers  of  national 
degeneracy  and  racial  decay  of  highly  civilized  races — 
dangers  which,  e.g.,  are  evidenced  in  a  lessened  rate  of 
fertility  under  the  conditions  of  civilized  life  (which  is 
man's  conscious  attempt  to  domesticate  himself)  ;  con- 
tinued high  infant  mortahty  in  spite  of  hygienic  progress ; 
the  enormous  presence  of  physical  defectiveness  (cf.  Chap- 
ters I  and  XVI),  and  the  alleged  prolific  increase  of  de- 
generate or  neuropatliic  offspring  (feeble-minded,  epilep- 
tic, criminal  and  insane).  These  problems  cannot,  in  the 
face  of  present  knowledge,  be  solved  in  any  rule-of-thumb 
fashion ;  they  must  be  solved  according  to  the  exigencies 
of  the  case  and  according  to  the  results  of  experience.  The 
ancient  Spartans  found  it  essential  to  their  national  safety 
to  exercise  practically  unlimited  supervision  over  the  physi- 
cal, hygienic,  social  and  educational  regimen  of  the  child, 
and  they  therefore  removed  him  entirely  from  the  family 
home.  During  these  latter  days  we  have  been  rapidly 
approximating  the  Spartan  ideal,  because  recent  condi- 
tions have  been  at  work  which  have  forced  a  return  toward 
it.     The  first  law  of  individual  as  well  as  of  national  life 


NEW  CLINICAL  PSYCHOLOGY  97 

is  the  law  of  self-preservation ;  against  this  primal  law  pre- 
conceived notions  and  paternalistic  or  communistic  phobias 
avail  naught.  The  patrons  of  the  schools  demand,  as  of 
right,  that  the  schools  shall  foster  those  agencies  and 
practices  without  which  they  cannot  realize  proper  divi- 
dends upon  their  investments,  and  without  which  the  forces 
in  the  modem  environment  which  are  destructive  of  the 
public  weal  cannot  be  successfully  combated.  Ultimately 
all  those  measures  must  surely  be  introduced  into  the 
schools  which  are  essentially  for  national  self-preservation ; 
the  fundamental  imperative  of  national  self-preservation 
will  take  precedence  over  all  other  considerations,  and 
theoretical  scruples  will  be  powerless. 

There  is  another  important  question  affecting  medical 
school  inspection  which  we  can  here  merely  raise:  Who 
should  be  eligible  for  appointment  as  medical  or  physical 
school  inspectors?  Many  of  the  present  incumbents  pos- 
sess neither  technical  training  nor  interest  in  the  work. 
This  is  one  reason  why  so  much  of  the  inspection  work  is 
perfunctory  and  thoroughly  unscientific.  A  class  of 
experts  for  this  work  scarcely  yet  exists,  because  at  the 
present  time  there  is  probably  not  a  university  or  medical 
school  in  the  country  that  provides  special,  technical 
training  in  medical  school  inspection.  Recently  short 
courses  of  this  character  have  been  given  by  Dr.  W.  S. 
Cornell  in  the  New  Jersey  Training  School  at  Vineland. 
Until  we  secure  a  class  of  expert  school  health  examiners — 
specialists  in  the  neuro-physical  and  developmental  defects 
and  maladies  of  childhood,  in  school  hygiene  and  sanita- 
tion, and  in  the  theory  and  practice  of  dento-medical  school 
inspection — appointees  should  be  selected  from  the  expert 
pediatricians  or  from  the  general  medical  practitioners 
who  show  a  vital  interest  in  the  distinctive  problems  of 


98      MENTAL  HEALTH  OF  SCHOOL  CHILD 

medical  school  inspection.  The  dental  work  should  be 
directed  by  a  doctor  of  dentistry. 

2.  Sociological,  personal  and  family  data.  We  cannot 
satisfactorily  diagnose  a  subnormal  or  defective  pupil  by 
merely  examining  his  present  bodily  conditions.  There 
are  other  influences,  hereditary,  developmental  and  envi- 
ronmental, which  have  contributed  to  make  him  what  he  is. 
These  we  must  understand.  We  must  know  something  of 
the  social  organisTn  of  which  he  is  a  constituent  member — 
something  of  his  home,  his  community,  his  street  life. 
The  out-of-school  activities  and  the  economic,  sanitary, 
hygienic,  moral  and  intellectual  conditions  of  the  home 
and  neighborhood  often  make  or  mar  the  individual. 
Properly  to  diagnose  his  condition  we  must  know  some- 
thing about  his  food  and  drink,  about  the  adequacy  of  his 
raiment  and  sleep,  about  the  purity  of  the  air  he  breathes, 
about  the  wholesomeness  of  the  games  and  amusements 
which  he  enjoys  and  the  resorts  wliich  he  frequents,  and 
about  the  care  and  treatment  which  he  receives  in  the 
home.  We  should  obtain  a  record  of  his  developmental 
history,  of  his  past  habits,  diseases,  disorders  and  eccen- 
tricities. Particularly  important  are  records  of  early 
dangerous  tendencies,  tantrums,  fits,  outbreaks  or  dis- 
orders or  diseases  which  are  'prodromal'  of  oncoming 
adolescent  or  adult  instabilities,  neurasthenias  and  psy- 
chasthenias.  And  properly  to  estimate  his  hereditary 
dower — his  inborn  capital  or  native  handicap — we  must 
know  something  of  the  stock  from  which  he  springs,  his 
direct  and  collateral  antecedents. 

The  two  fundamental  factors  which  make  or  mar  the 
life  of  every  child  are  heredity  and  environment.  But  it  is 
impossible  to  determine  offhand,  and  frequently  even  after 
considerable   study,   which  of  these   two   factors  is   more 


NEW  CLINICAL  PSYCHOLOGY  99 

largely  responsible  for  a  child's  degeneracy  or  delinquency. 
The  view  that  acquired  degeneracy  exceeds  the  inherited 
became  rather  prevalent  some  time  ago,  perhaps  as  a 
reaction  against  the  Italian  or  Lombroso  school  of  crimi- 
nologists who  manifest  an  exaggerated  tendency  to  refer 
all  mental  abnormalities  to  biological  causes,  and  who 
maintain  that  there  is  a  very  prevalent  degenerate  (spe- 
cifically criminal)  type  which  is  born  and  not  made.  But 
recent  heredity  studies  of  feeble-mindedness,  epilepsy  and 
insanity  show  the  preponderant  influence  of  neurotic 
ancestral  strains.  Be  this  as  it  may,  it  is  unquestionable 
that  a  vast  amount  of  abnormal  conduct  is  acquired  from, 
or  accentuated  by,  a  bad  environment ;  from  physically  and 
morally  unclean  slums,  from  squalid  or  unhealthy  homes, 
from  vicious  resorts,  social  vices,  unhygienic  school  prac- 
tices and  habits,  etc.  The  first  treatment  which  a  child 
reared  in  the  underworld  needs  is  to  be  rescued:  he  must 
either  be  removed  from  his  evil  surroundings  or  his  environ- 
ment must  be  reformed.  This  accompUshed,  he  must  be 
supplied  with  proper  training,  food,  sleep,  exercise  and 
clothing.  Instances  of  children  who  have  been  transformed 
in  body  and  mind  by  these  measures  have  been  frequently 
recorded;  modern  'hospital'  or  'orthogenic'  schools  are 
demonstrating  what  can  be  done  through  the  work  of 
scientific,  educational  and  social  reclamation. 

Obviously  it  would  be  folly  to  aim  to  include  in  the  above 
survey  all  the  pupils  of  the  school.  At  best  we  must  be 
satisfied  to  include  only  the  problematic  or  defective  cases. 
Much  valuable  information  can  be  gathered,  of  course, 
by  teachers,  principals  and  school  nurses ;  but  a  field 
worker,  trained  in  social  survey  work,  should  be  added  to 
the  staff  for  this  particular  type  of  service. 

3.     Pedagogical  records  from  the  schools.    The  bureau 


100    MENTAL  HEALTH  OF  SCHOOL  CHILD 

we  are  advocating  should  also  keep  on  file  the  pupil's 
school  reports  and  records,  particularly  the  records  of  the 
'problem'  pupils — feeble-minded,  backward,  neurotic, 
truant,  etc.  These  records,  to  be  made  out  by  classroom 
teachers  and  principals,  should  contain  facts  in  regard  to 
the  child's  age  and  grade  (pedagogical  retardation),  the 
number  of  months  he  has  been  in  school,  the  grades  re- 
peated, the  amount  and  type  of  work  that  he  has  been  able 
and  that  he  has  not  been  able  to  do,  his  attitudes,  disposi- 
tions, demeanor,  behavior,  dominant  interests  and  aver- 
sions, vocational  bias,  regularity  of  attendance,  etc.  Such 
records  will  attain  a  unique  value  when  studied  in  the  hght 
of  the  data  from  other  sources. 

4t.  The  results  of  controlled  educational  experiments. 
A  department  of  experimental  pedagogy  should  be  one 
division  of  a  complete  bureau  of  school  research.  This 
department  should  study,  under  principles  of  scientific 
control,  the  important  school  problems  in  pedagogy: 
methods  of  teaching  and  learning  various  branches,  rest 
and  work  periods,  fatigue,  recreation,  the  relation  of 
temperature  to  working  efficiency,  the  content  and  articu- 
lation of  courses,  etc.  It  should  standardize  efficiency  tests 
and  apply  pedagogical  measuring  scales  in  the  various 
branches  of  study.  Some  of  the  problems  would  be  solved 
experimentally  in  the  laboratory ;  others  could  best  be 
solved  by  controlled  school  tests,  and  others  would  be 
studied  in  special  experimental  schools.  The  laboratory 
connected  with  the  Chicago  schools  has  devoted  a  slight 
amount  of  attention  to  problems  of  this  character.  The 
results  of  the  pedagogical  experiments  should  be  corre- 
lated with  the  other  data  in  the  bureau. 

5.  Psycho-clinical  records  from  the  department  of 
clinical  psychology.     One  of  the  most  important  divisions 


NEW  CLINICAL  PSYCHOLOGY  101 

of  the  bureau  should  be  a  laboratory  of  clinical  psychology 
for  the  individual  study  of  pupils,  particularly  subnormal, 
supernormal  and  delinquent  children.  The  central  aim  of 
this  department — we  shall  discuss  it  somewhat  in  detail 
presently — should  be  the  scientific  investigation  of  abnor- 
malities of  psycho-educational  development. 

Conceived  in  this  large  way,  the  bureau  of  school 
research  would  become  a  large  scientific,  educational  clear- 
ing house,  a  vital  agency  for  the  scientific  correlation  of 
pedagogical  facts  and  a  potent  instrument  for  the  dis- 
semination of  reliable  educational  data.  It  is  only  when 
we  view  the  child  from  all  angles — from  the  bodily,  the 
psychical,  the  pedagogical,  the  sociological,  the  develop- 
mental and  the  hereditary — that  we  are  in  a  position 
thoroughly  to  understand  him,  and  that  we  are  able  to 
deal  effectively  with  the  problems  of  mental  exceptionality. 

Perhaps  we  can  best  illustrate  the  point  we  wish  to  make 
by  reference  to  the  questions  of  retardation  and  accelera- 
tion, which  are  far  more  complex  than  would  be  supposed 
at  first  blush.  When  we  are  dealing  with  the  development 
of  a  child  we  are  dealing  not  with  a  single  equation,  but 
with  a  number  of  variable  equations.  Instead  of  one  con- 
stant age,  we  may  speak  of  a  child  as  having  six  ages :  a 
chronological,  a  physiological,  an  anatomical,  a  socio- 
industrial,  a  pedagogical  and  a  psychological.  So  far  as 
the  chronological  age  is  concerned,  there  can  be  no  question 
of  retardation ;  a  child  born  precisely  fifteen  years  ago  is 
chronologically  exactly  fifteen  years  old.  But  physiologi- 
cally, anatomically,  pedagogically,  socio-industrially  and 
psychologically  his  development  may  spread  over  a  number 
of  ages.  Physiologically,  our  fifteen-year-old  child  may 
be,  say,  only  thirteen  years  old.  Measured  by  the  ma- 
turity of  bodily  functions,  e.g.,  by  the  degree  of  pubertal 


102    MENTAL  HEALTH  OF  SCHOOL  CHILD 

or  pubescent  development  (or  size,  which  it  is  claimed, 
roughly  corresponds,  6),  he  has  the  body  of  a  nonnal 
child  of  thirteen.  He  is  physiologically  two  years  re- 
tarded. Anatomically — i.e.,  measured  by  structural 
changes,  particularly  by  the  degree  of  ossification  of  the 
cartilage,  Rotch's  X-ray  method — he  may  be  fourteen 
years  old,  or  only  a  year  retarded.  Measured  by  the 
socio-industrial  or  motor  standard — i.e.,  by  his  rate  of 
acquiring  the  fundamental  social  functions  and  various 
motor  or  industrial  operations — he  may  be  sixteen  years 
old,  or  a  year  accelerated.  Similarly,  our  fifteen-year-old 
child  may  be  retarded  pedagogically  three  years ;  i.e., 
assuming  that  he  started  school  on  time  and  has  arrived  at 
his  present  grade  three  years  later  than  his  classmates  in 
the  first  grade,  he  has  a  pedagogical  development  of 
twelve  years.  He  is  pedagogically  retarded,  whatever  the 
cause — mental  defect,  physical  handicap,  frequent  absence, 
transfer,  lack  of  application,  etc.  Finally,  the  psychical 
age  of  our  fifteen-year-old  may  be,  say,  only  eleven ;  he  has 
the  mental  development  of  a  child  of  that  age.  It  might 
be  assumed  that  the  pedagogical  and  mental  ages  would 
coincide.  At  times  they  will,  but  by  no  means  always. 
The  child's  pedagogical  retardation  may  be  due  merely  to 
late  entrance,  irregular  attendance,  frequent  transfers, 
lack  of  interest  in  the  particular  tasks  set  by  the  school, 
or  because  some  temporary  handicap  may  have  especially 
crippled  those  mental  functions  {e.g.,  memory  and  atten- 
tion) which  play  an  important  role  in  the  learning 
processes  of  the  school,  in  which  case  the  pedagogical 
retardation  may  be  greater  than  the  mental.  On  the  other 
hand,  his  pedagogical  retardation  may  be  less  than  his 
mental,  for  he  may  have  been  promoted  undeservedly 
(32)  ;  or  his  abilities  may  have  been  overestimated,  owing 


NEW  CLINICAL  PSYCHOLOGY  103 

to  a  heightened  development  of  some  special  mental  func- 
tion {e.g.,  memory)  ;  or  he  may  have  been  pushed  forward 
because  of  the  pressure  brought  to  bear  on  the  classroom 
teacher  to  eliminate  failures  or  to  minimize  the  number  of 
non-promotions.  Accordingly,  the  child's  actual  mental 
development  needs  to  be  determined  independently  by 
serial  graded  age-tests,  which  are  sufficiently  compre- 
hensive to  include  tests  of  the  fundamental  mental  func- 
tions, capacities  and  powers.  Until  recently  we  had  no 
such  tests — no  measures  of  mental  age  that  were  regarded 
as  scientifically  valid.  Now,  thanks  to  the  laborious  and 
ingenious  investigations  of  Binet  and  his  co-worker,  Simon, 
we  have  a  set  of  graded  tests  which  render^  it  possible 
somewhat  approximately  to  ascertain,  in  terms  of  age,  the 
intellectual  status  of  a  child  below  the  teens  or  the  degree 
in  which  his  intellectual  development  varies  from  the  aver- 
age or  typical  child  of  his  chronological  age.  While  these 
tests  are  neither  exhaustively  comprehensive,  'amazingly 
accurate'  nor  'infallible' — as  recent  experimental  studies 
show  (1,  12,  15,  19,  21,  28,  31)  and  as  I  shall  point  out 
in  later  pages,  they  give  us  a  consistent,  practical,  im- 
personal, objective,  scientific  method  of  determining 
psychological  retardation,  which  is  of  considerable  service 
to  the  expert  psycho-diagnostician.  Standardized,  graded 
intelligence  tests  should  be  given  in  all  the  large  school  sys- 
tems under  the  direction  of  a  qualified  expert. 

The  School  Psycho-educational  Laboratory 

Where  the  establishment  of  a  bureau  of  school  research 
upon  the  comprehensive  plan  sketched  above  is  not  feasible, 
the  most  urgent  need  should  be  provided  for,  namely,  the 
establishment  of  a  clinical  laboratory  for  the  examination 
and  grading  of  retarded  children. 


104    MENTAL  HEALTH  OF  SCHOOL  CHILD 

I  do  not  intend  to  imply  that  only  the  retarded  child 
should  receive  the  advantages  of  scientific  diagnosis.  No 
type  of  cliild  has,  perhaps,  been  so  thoroughly  neglected 
as  the  supernormal  child,  the  child  on  the  plus  side  of  the 
curve  of  efficiency.  This  is  probably  due  largely  to  the 
fact  that  'accelerated'  children  are  not  nearly  so  numerous 
as  retarded  children,  as  shown  by  the  available  surveys, 
and  to  the  fact  that  they  do  not  encumber  the  machinery 
of  the  schools  as  do  the  retarded  pupils.  The  supernormal 
or  precocious  child  is  the  incipient  genius ;  and  it  is  chiefly 
through  the  constructive  achievements  of  its  geniuses  that 
civihzation  advances.  Both  of  the  extreme  types  of  the 
'special'  cliild  merit  special  study  and  treatment:  the  suh- 
normal  child,  in  order  that  he  may  be  relieved,  so  far  as 
possible,  of  his  physical  and  mental  handicaps,  so  that  he 
may  become  as  little  of  a  burden  to  society  as  possible ;  and 
the  supernormal  child,  in  order  that  he  may  be  surrounded 
with  those  conditions  which,  on  the  positive  side,  make  for 
the  freest  and  largest  development  of  his  potentialities,  and 
which,  on  the  negative  side,  will  not  serve  to  distort,  abort 
or  repress  his  natural  powers.  Since  it  is  probable  that 
most  of  the  new  laboratories  which  will  be  established  will 
be  dedicated  to  the  study  of  the  subnormal  child,  it  is  to 
be  hoped  that  a  laboratory  will  be  established  with  the 
express  and  exclusive  aim  of  studying  the  supernormal 
child,  and  that,  eventually,  all  the  large  public  schools  will 
organize  definite  plans  for  conserving  and  furthering  the 
interests  of  its  incipient  geniuses.  Nevertheless,  the  enor- 
mous prevalence  of  retarded  as  compared  with  accelerated 
pupils  makes  the  identification  and  segregation  of  feeble- 
minded and  backward  children  the  problem  of  paramount 
importance. 

In  New  York  City  there  are  eight  slow-progress  pupils 


NEW  CLINICAL  PSYCHOLOGY  105 

for  every  rapid-progress  pupil ;  in  a  Massachusetts  city 
the  relation  was  found  to  be  21  to  1 ;  in  a  Pennsylvania 
city,  14!tol  (13);  among  8,942  graded  pupils  in  Bureau 
County,  Ilhnois,  57.5  per  cent  were  behind  the  normal,' 
while  only  8  per  cent  were  ahead,  and  among  2,090  rural 
pupils,  53.5  per  cent  were  retarded,  and  only  12  per  cent 
ahead;  of  the  137  pupils  whose  records  were  traced 
through  the  grades  in  Princeton,  111.,  69.3  per  cent  were 
behind  time,  and  only  4.6  per  cent  accelerated  (8,  9)  ;  in 
a  Baltimore  class,  where  the  progress  and  retardation  was 
likewise  traced  for  43  pupils  from  the  first  to  the  eighth 
grade,  77  per  cent  arrived  late,  while  only  one  arrived 
ahead  of  time  (16)  ;  in  three  Chicago  schools  the  per  cent 
retarded  was  68.1,  the  per  cent  accelerated  8.1 ;  in  Cin- 
cinnati (report  of  1907:  26)  the  proportion  was  58.4  per 
cent  to  9.6  per  cent ;  in  Mauch  Chunk  township.  Pa.,  34.5 
per  cent  to  16.6  per  cent  (for  842  pupils  studied;  most  of 
the  accelerated  started  early:  30)  ;  in  five  cities  studied  the 
retarded  were  from  10  to  150  times  as  numerous,  and  in  29 
other  cities  from  8  to  10  times  as  numerous  (Ay res).  It 
has  been  said  that  three  out  of  every  four  must  do  one 
room  twice,  and  statistics  show  that  from  33  to  50  per  cent 
of  the  pupils  in  the  schools  are  over  age  for  their  grade. 

In  the  light  of  these  statistics — and  I  have  given  a  mere 
hint  of  the  available  data — it  becomes  imperative  to  under- 
take a  thorough  study  of  the  extent,  causes,  results  and 
treatment  of  retardation — the  great  threatening  colossus 
of  the  modern  school.  It  is  particularly  important  to 
make  psycho-educational  examinations  to  determine  the 
degree  of  the  mental  deficit  of  the  retardate,  to  determine 
whether  the  retardation  is  a  case  of  inherent  deficiency  or 
subnormal  mental  development,  or  whether  it  is  the  result 
of  adventitious   factors,   such  as   late  entrance,  transfer, 


106    MENTAL  HEALTH  OF  SCHOOL  CHILD 

irregularity  of  attendance,  illness,  physical  defectiveness, 
language  deficiency,  home  abuse,  poor  teaching,  lack  of 
individual  tuition,  maladapted  courses,  indifference,  etc. 
Until  the  schools  make  greater  efforts  to  discover  the 
cause  of  the  lack  of  progress  of  the  individual  retardate, 
the  orthogenic  treatment  cannot  be  made  scientifically 
accurate  or  practically  effective.  It  is  the  worst  sort  of 
possible  economy  to  attempt  to  train  subnormal  children 
without  a  prior  scientific  educational  diagnosis. 

The  Specific  Functions  of  the  School's  Psycho- 
educational,  Labouatoey 

1.  The  clinical  examination  of  exceptional  children. 
Every  child  retarded  pedagogically  over  one  year  should 
be  given  a  special  preliminary  medical  examination, 
and  then  referred  to  the  laboratory  for  a  psycho-educa- 
tional examination.  The  tests  should,  where  possible, 
include  graded  serial  tests  for  determining  mental  age, 
form-board  tests,  sensory-motor  tests,  which  have  a  diag- 
nostic value  (auditory  and  visual  acuity,  motor  skill,  co- 
ordination, hand  dynamometry,  endurance,  body  sway)  ; 
selected  standardized  tests  of  fundamental  intellectual 
traits  (memory,  spontaneous  and  controlled  association, 
accuracy  and  quickness  of  perception  and  observation, 
recognition,  linguistic  construction,  learning  capacity)  ; 
speech  tests,  certain  physical  and  anthropometric  growth 
measures  (sitting  and  standing  height,  weight,  thoracic 
perimeter,  spirometry,  head  circumference,  together  with 
vital,  ponderal  and  statural  indices,  and  perhaps  tests  of 
anatomical  age),  and  certain  reflex  action  tests.  In 
selected  cases  the  psycho-analytic  (Freud)  and  reaction- 
association  (Jung)  tests  may  be  relevant  for  purposes  of 


NEW  CLINICAL  PSYCHOLOGY  107 

diagnosis  of  more  fundamental  or  obscure  mental  abnor- 
malities. Anthropometric  percentile  curves  and  indices 
should  be  plotted  for  each  child,  showing  his  status  relative 
to  the  normal  child  of  the  same  chronological,  and  perhaps 
also  anatomical  and  psychological  age.  To  plot  such 
curves  we  stand  in  need  of  reliable  norms  for  typical, 
average  or  normal  children.  Since  we  do  not  now  have 
fully  satisfactory  norais,  one  of  the  functions  of  the 
laboratory  at  the  present  time  should  be : 

2.  The  establishment  of  thoroughly  reliable  anthropo- 
metric norms  for  normal  children.  To  be  sure,  we  already 
have  anthropometric  norms  for  certain  functions,  e.g., 
those  worked  out  by  the  Department  of  Child  Study  and 
Pedagogic  Investigation  of  the  Chicago  schools.  These 
norms  are  perhaps  reliable  so  far  as  they  go,  and  have 
sufficient  validity  to  enable  us  to  proceed  at  once,  without 
awaiting  confirmatory  or  more  elaborate  measurements, 
to  measure  and  grade,  with  considerable  confidence,  any 
given  child,  whether  subnormal,  normal  or  supernormal. 
Yet  the  fact  remains  that  it  is  still  desirable  to  repeat 
Smedley's  percentile  measurements  (or  measurements 
designed  to  give  anthropometric  indices,  whichever  type 
of  measurement  ultimately  will  prove  the  more  valuable) 
on  height,  weight,  vital  capacity,  manuometry,  endurance 
and  other  functions  on  a  much  larger  scale  and  under  more 
satisfactory  conditions.®  For  Smedley's  norms  are  not 
entirely  satisfactory  in  four  respects : 

In  the  first  place,  they  are  based  upon  the  examination 
of  too  few  persons.  To  secure  thoroughly  reliable  normal 
norms  we  should  examine  at  least  1,000  persons  of  each 

8  The  task  involved  in  gathering  reliable  mental  and  physical  norms, 
for  both  children  and  adults,  is  herculean,  and  would  require  the 
combined  eflforts  of  many  workers.     The  work  should  be  organized 


108    MENTAL  HEALTH  OF  SCHOOL  CHILD 

sex  for  each  year,  and  each  one-half  year  during  early 
childhood.  Smedley's  numbers  for  given  ages  ranged  from 
44  (ages  nineteen  and  twenty,  boys)  to  448.  I  do  not 
believe  that  in  a  country  like  the  United  States  where  so 
many  nationalities  commingle  we  can  be  satisfied  with  one 
hundred  for  each  age. 

In  the  second  place,  we  have  no  evidence  that  the  norms 
are  normal  norms;  i.e.,  that  they  are  based  upon  the  exami- 
nation of  typical  or  normal  children.  In  fact,  the  proba- 
bility almost  amounts  to  a  certainty  that  a  considerable 
number  of  the  pupils  examined  were  more  or  less  subnormal 
or  abnormal.  It  is,  therefore,  possible  that  the  percentile 
curves  or  indices  for  any  case  of  retardation  plotted  on  the 
basis  of  these  results  will  misrepresent  the  development  of 
the  pupil  in  comparison  wdth  normal  children.  Measure- 
ments seem  to  show  that  anthropological  indices  are 
atypical  for  mentally  abnormal  persons. 

Of  course,  the  concept  of  a  normal  norm — a  typical, 
normal  individual — is  quite  fluid  or  elastic.  How  shall  we 
determine  who  is  normal  in  advance  of  making  the  tests.'' 

by  a  public  or  endowed  private  bureau  of  research,  so  that  it  may 
be  done  with  sufficient  thoroughness,  so  that  uniform  or  standardized 
methods  may  be  used,  and  so  that  the  results  may  be  worked  up  in 
the  most  serviceable  form.  Properly  to  study  any  given  individual — 
normal,  criminal,  insane,  demented,  amented — we  must  have  individual 
and  typical  'percentile  curves  or  indices  of  physical  development,  and 
standards  of  mental  attainment  for  various  ages. 

I  know  of  no  form  of  public  service  which  merits  more  fuUy  the 
liberal  support  of  philanthropic  persons  who  have  the  interests  of 
child  reclamation  or  eugenics  at  heart.  It  is  a  work  that  should  be 
munificently  endowed.  One  of  the  essential  functions  of  the  RusseU 
Sage  Foundation,  and  the  Government  Bureau  of  Child  Welfare, 
might  well  be  the  establishment  of  mental  and  physical  norms  of 
development.  Meanwhile,  our  psycho-clinical  school  laboratories 
should  contribute  their  mite  toward  obtaining  these  norms  for 
persons  of  school  age. 


NEW  CLINICAL  PSYCHOLOGY  109 

This  is  extremely  difficult  to  say.  Unless  we  are  satisfied 
to  use  random,  unselected  groups  and  assume  a  symmetri- 
cal curve  of  distribution,  we  must  adopt  some  criteria. 
So  far  as  I  know  there  are  only  two  criteria  which  are  at 
all  available  for  selecting  normal  school  children :  namely, 
school  grade  (pedagogical  status)  and  degree  of  physical 
defectiveness. 

On  the  basis  of  the  first  standard,  the  pupils  of  a  given 
age  who  satisfactorily  carry  the  work  of  the  school  grade 
to  which  they  chronologically  belong  (or  of  an  earlier 
grade  in  case  of  late  entrance),  may  be  considered  mentally 
normal. 

The  other  method  of  selection  is  based  upon  the  physical 
and  medical  examination  of  the  child.  That  child  may  be 
regarded  as  physically  normal  who  does  not  possess  serious 
physical  defects,  or  in  whom  the  ravages  of  infant  and 
childhood  diseases  have  not  resulted  in  pronounced  physi- 
cal impairment.  In  other  words,  those  children  would  be 
physically  normal  who  suffer  only  from  the  ordinary 
amount  of  physical  defectiveness.  Even  under  the  best 
conditions  of  modem  life,  the  child  with  assumed  'normal' 
motor  and  sensory  equipment  will  show  some  traces  of 
physical  defectiveness  (21,  22).  It  is,  therefore,  chiefly 
important  to  exclude  all  the  extreme  departures  from 
physical  normality. 

Both  of  these  methods  of  selection  are  practical,  and 
the  norms  obtained  by  them  ought  more  genuinely  to 
represent  normal  norms  than  the  norms  obtained  by  testing 
unselected  cases.  The  validity  of  the  latter  must  always 
rest  on  the  assumption  that  there  are  just  as  many  super- 
normal or  accelerated  as  subnormal  or  retarded  indivi- 
duals. This  I  regard  as  improbable.  Norms  secured 
according  to  the  above  suggestions  would  not  only  give  us 


110    MENTAL  HEALTH  OF  SCHOOL  CHILD 

valuable  measures  of  the  mental  and  physical  powers  and 
capacities  of  people  of  the  present  generation — racial  and 
national  indices — but  indices  by  means  of  which  to  deter- 
mine the  character  and  extent  of  the  changes  in  human 
functions  which  are  gradually  taking  place  through  hered- 
itary propulsion  and  environmental  influences. 

In  the  third  place,  Smedley's  range  of  ages,  from  four 
to  twenty-one  (or  'twenty-one  years  and  over'),  is  too 
limited.  It  embraces  merely  the  periods  of  childhood  and 
adolescence.  We  need  norms  for  infancy  and  the  adult 
or  the  ebb  period  of  life  as  far  as  the  age  of  forty  or  fifty, 
at  least.  Such  norms  would  perhaps  have  no  immediate 
practical  value  for  the  public  schools,  juvenile  courts  or 
correctional  and  rescue  homes  for  the  young,  but  to  the 
student  interested  in  the  scientific  study  of  the  problems 
of  human  evolution  or  in  the  study  of  the  degenerative, 
involution,  senescent  changes  peculiar  to  the  process  of 
aging,  or  in  the  study  of  the  various  physical  and  mental 
deviations  peculiar  to  various  classes  of  defectives  (feeble- 
minded, epileptic,  insane,  criminal,  paralytic,  etc.),  they 
would  possess  unusual  value.  At  the  present  time  we  have 
little  knowledge  that  is  scientifically  accurate  regarding 
the  growth  (developmental  or  retrogressive)  changes 
peculiar  to  middle  and  old  age,  because  the  norms  are 
practically  nonexistent. 

In  the  fourth  place,  Smedley's  percentiles  are  given  for 
whole  ages  only — 4,  5,  6,  7,  8,  9,  etc.  A  child  who  is  six 
years  and  one  day  old  is  grouped  with  one  who  is  six  years 
and  364  days  old.  Consequently,  children  who  are  prac- 
tically one  year  apart  in  age  may  be  grouped  together. 
This  tends  to  introduce  a  considerable  error,  owing  to  the 
kaleidoscopic  developmental  changes  which  occur  during 
the  growth  period.     During  this  period  the  results  which 


NEW  CLINICAL  PSYCHOLOGY  111 

are  valid  for  the  youngest  child  of  a  given  age  may  grossly 
misrepresent  the  oldest  child  of  that  age.  Accordingly,  a 
better  plan  would  be  to  group  children  by  half -ages,  thus : 
4,  4l^,  5,  5^,  etc.  Thus,  the  six-year  group  would  include 
children  from  five  years  ten  months  (beginning  of  tenth 
month)  to  six  years  three  months  (end  of  third  month), 
while  the  six  and  one-half-year  group  would  include  cliil- 
dren  from  six  years  four  months  (beginning  of  fourth 
month)  to  six  years  nine  months  (end  of  ninth  month). 
(I  am  now  establishing  certain  norms  according  to  tliis 
plan.)  In  other  words,  children  are  grouped  under  a  given 
age-designation  whose  age  is  within  three  months  in  either 
direction  of  that  designation.  For  the  years  following, 
the  early  growth  period  of  the  present  grouping  by  whole 
ages  is  probably  satisfactory. 

What  has  been  said  above  applies  to  all  kinds  of  norms : 
it  must  be  emphasized  that  the  norms  required  are  not 
merely  physical  and  anthropometric,  but  also  psychical 
and  pedagogical. 

3.  The  establishment  of  thoroughly  reliable  psycho- 
logical norms  of  development  for  normal  children.  Every- 
thing that  has  been  urged  in  respect  to  the  need  of  estab- 
lishing normal  anthropometric  norms  and  indices  applies 
to  the  establishment  of  normal  mental  age  norms  of  the 
important  intellectual,  motor  and  emotional  functions. 
It  will  be  impossible  to  make  strictly  reliable  tests  until 
these  norms  are  available  on  a  much  larger  scale  than  we 
now  have  them.  It  is  also  important  to  establish  reliable 
objective  pedagogical  age-norms:  but  this  work  is  large 
enough  to  demand  the  services  of  a  special  division  of  peda- 
gogic research. 

4.  The  psycho-clinical  laboratory,  in  the  fourth  place, 
should  serve  as  a  clearing-house  for  all  types  of  mentally 


112    MENTAL  HEALTH  OF  SCHOOL  CHILD 

and  educationally  unusual  children — a  function  which  it 
should  discharge  jointly  with  the  special  schools  or  special 
classes.  At  the  present  time  the  special  schools  serve  this 
function  very  inadequately ;  they  have  become  rather  a 
dumping  ground  for  the  ne'er-do-wells,  the  offscourings, 
of  the  schools — a  place  to  which  they  may  be  relegated 
indiscriminately  in  order  to  reHeve  the  regular  rooms  of 
an  intolerable  incubus.  After  the  backward  child  has  been 
examined  in  the  laboratory,  he  should  be  sent  to  a  special 
class  (one  in  charge  of  a  teacher  specially  trained  for 
special- room  work),  with  specific  recommendations,  for 
further  careful  pedagogical  observation  and  psychological 
study.  He  should  be  given  a  well-planned  try-out  for  a 
while,  the  results  of  which  should  be  sent  to  the  laboratory. 
On  the  basis  of  these  results — the  clinical  examination  and 
special-room  observation  and  testing — the  director  should 
recommend  the  transfer  to,  or  the  placing  of  the  child  in, 
his  proper  place — the  special  class  for  the  feeble-minded, 
the  special  class  for  the  backward,  the  ungraded  class  for 
the  retarded  (those  merely  retarded  in  one  or  more  of  the 
academic  branches),  the  classes  for  the  blind,  deaf,  crip- 
pled, tuberculous,  anemic  or  speech-defective,  or  the  insti- 
tutions for  the  feeble-minded  or  epileptic.  Most  elementary 
pupils  who  are  mentally  retarded  more  than  four  years  are 
suffering  from  very  serious  permanent  arrest,  and  are 
institutional  cases.  They  should  be  separated  from  the 
merely  retarded  and  the  backward.  The  recommendations  [ 
of  the  director  should  not  be  subject  to  reversal,  except  i 
through  action  by  the  board  or  the  superintendent.  As  a  i 
clearing-house  for  mentally  unusual  pupils,  the  laboratory 
would  render  an  important  service  to  the  schools  not  per- 
formed by  any  existing  agency.  It  is  evident  that  to 
perform    this    service    in    the    best    possible    manner    the 


NEW  CLINICAL  PSYCHOLOGY  113 

laboratory  must  be  directed  by  an  authoritative  specialist 
and  have  available  full  data  from  the  other  sources  which 
we  have  already  discussed.  Where  there  is  no  complete 
bureau  of  school  research,  the  psycho-educational  labora- 
tory would  logically  assume  the  functions  of  such  a  bureau. 

5.  A  fifth  function  of  the  laboratory  is  the  psycho- 
logical examination  and  efficiency  appraisal  of  some  of  the 
applicants  for  vocational  guidance.  As  already  stated, 
it  is  preposterous  to  assume  that  the  mass  of  children  can 
be  scientifically  guided  into  vocational  pursuits  without 
such  an  examination.  The  director  of  the  vocational 
bureau  should  be  a  psycho-educational  expert,  or  the 
services  of  such  an  expert  should  be  available  to  the 
bureau  for  the  examination  of  at  least  all  the  candidates 
whose  educational  record  indicates  that  they  are  mentally 
exceptional, 

6.  The  laboratory  may  also  undertake  the  training  of 
special-class  teachers  in  the  psycho-clinical  methods  of 
testing  pupils.  If  it  were  feasible,  the  teachers  might 
assist  in  giving  some  of  the  tests  in  the  special  schools 
under  the  supervision  of  the  laboratory  director.  The 
percentage  of  retarded  children  is  so  large  that  it  would 
probably  be  beyond  the  means  of  the  laboratory  to  examine 
all  the  pupils  who  should  be  examined  in  a  large  school 
system.  To  apply  merely  the  Binet-Simon  tests 
thoroughly  requires  from  forty  minutes  to  an  hour.  How- 
ever, a  distinctly  better  plan  is  to  specially  train  one  or 
two  adaptable  teachers  in  the  methods  of  psychological 
testing,  and  let  them  devote  all  their  time  to  giving  some 
of  the  simpler  tests.  The  more  difficult  tests  and  the  final 
review  of  the  cases  should  invariably  be  made  by  the  expert 
clinical  psychologist. 


114    MENTAL  HEALTH  OF  SCHOOL  CHILD 

7.  Finally,  another  function  of  the  laboratory  might 
he  the  supervision  of  the  curricula  of  the  special  schools 
and  the  offering  of  courses  in  the  training  school  on  the 
psychology  and  pedagogy  of  the  various  types  of  mental 
deviation  or  deficiency.  No  teacher  should  ever  be 
assigned  to  special  class  work  who  has  not  received  special 
training.  It  is  obvious  that  to  perform  all  these  functions 
the  laboratory  would  have  to  be  organized  on  a  compre- 
hensive basis. 

The  Qualifications  of  the  Clinical  Psychologist  oe 
Psycho-educational  Examiner 

1.  He  must  be  temperamentally  adapted  for  the  work. 
I  do  not  know  that  this  is  first  in  importance,  but  mere 
knowledge  of  the  methodological  technique  peculiar  to 
psycho-clinical  work  does  not  necessarily  make  a  successful 
examiner.  The  examiner  must  have  the  ability  or  knack 
to  draw  out  the  best  the  child  has  to  give ;  if  he  is  obliged 
to  force  it  out  he  is  lacking  in  the  very  essentials  of  the 
work.  Psycho-chnical  examination  is  not  a  forcing-out 
process.  The  examiner  should,  through  word,  action, 
demeanor  and  bearing,  be  able  to  calm,  pacify,  set  at  ease 
the  nervous,  excitable  child ;  and  to  encourage,  incite,  stim- 
ulate the  phlegmatic,  timid,  taciturn,  obstructed  child. 
He  must  be  genial,  friendly,  sympathetic,  quick  to  praise 
and  slow  to  criticise,  and  must  be  able  to  win  the  confidence 
of  all.  He  must  possess  an  unlimited  reserve  of  patience 
with  the  frivolous,  the  resistant  and  the  snail-like  plodders. 
He  must  be  versatile  and  resourceful,  so  that  he  can  change 
his  attitude  and  method  of  attack  to  suit  all  types  of 
persons.      There   are   persons   who   will   respond   only   to 


NEW  CLINICAL  PSYCHOLOGY  115 

pressure  and  with  whom  stem  measures  will  produce  the 
best  results.    But  they  are  entirely  exceptional. 

2.  It  is  not  enough  that  he  has  a  thorough  grounding 
in  the  methods  and  results  of  analytical,  descriptive, 
experimental,  child,  social,  physiological  and  educational 
psychology ;  he  should  have  a  definite,  technical  prepara- 
tion in  clinical  psychology.  He  should  be  conversant  with 
its  methods,  standpoints,  aims  and  results.  Knowledge  of 
structural  psychology  is  not  sufficient ;  the  best  structural 
and  experimental  psychologist  may  make  the  sorriest 
clinical  psychologist.  Often  the  paramount  need  is  the 
ability  to  tear  loose  from  the  abstractions,  schematizations 
and  viewpoints  of  the  structuralist.  The  clinical  worker 
must  use  the  'case'  method  of  procedure;  he  must  be 
familiar  with  the  clinical  method ;  he  must  be  able  to  indi- 
vidualize each  case  (a  capacity  that  is  likewise  needed  by 
the  special-class  teacher),  to  study  it  in  the  concrete,  to 
frame  a  clinical  picture  of  it — in  a  word,  to  examine  clini- 
cally. To  do  this  requires  more  than  a  mastery  of  the 
framework  of  psychology  or  of  the  technique  of  laboratory 
experimentation ;  it  requires  ready  powers  of  observation, 
keenness  of  insight,  power  to  interpret,  ability  to  notice 
signs  and  symptoms,  a  knowledge  of  symptomatology  and 
of  the  best  available  methods  of  psycho-clinical  diagnosis, 
and  an  extensive  first-hand  acquaintance  with  education- 
ally abnormal  children — three  to  four  years  of  observation 
and  testing  in  and  out  of  institutions  of  a  considerable 
variety  of  child  deviates,  such  as  the  feeble-minded,  back- 
ward, retarded,  accelerated,  epileptic,  incipient  and  devel- 
oped neurotics  and  psychotics,  speech  defectives,  moral 
imbeciles.  Until  recently  it  was  impossible  to  obtain 
adequate  training  in  clinical  psychology  except  through 
an  apprenticeship  with  one  of  the  few  experts  in  the  field. 


116    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Now  a  few  universities — although  very  few — are  able  to 
offer  satisfactory  didactic  and  clinical  courses  in  the  psy- 
chological and  educational  examination  of  children. 

3.  A  knowledge  of  anatomy  and  pathology,  of  public 
and  personal  hygiene,  of  the  common  physical  defects,  of 
nervous  and  mental  diseases,  of  psychopathology  and  psy- 
chotherapy, of  pediatrics  and  normal  physical  diagnosis, 
is  essential  for  a  clinical  psychologist  working  on  juvenile 
cases  in  the  medical  school;  I  incline  strongly  to  the 
opinion  that  the  psychological  and  educational  examiner 
of  mentally  unusual  children  in  the  schools  should  also  have 
a  working  knowledge  of  these  specialties. 

4.  The  clinical  psychologist  should  be  thoroughly 
grounded  in  the  science  and  art  of  normal  pedagogy.  He 
will  certainly  be  able  to  render  a  higher  type  of  service  if 
he  has  had  practical  teaching  experience  in  the  elementary 
grades  of  the  public  schools,  so  that  he  has  had  the  oppor- 
tunity to  come  directly  in  touch  with  the  problems  of  the 
training,  growth  and  development  of  the  child  mind,  and 
so  that  he  is  thoroughly  conversant  with  the  normal  peda- 
gogy of  the  elementary  branches  (particularly  the 
methods  of  teaching  handwork,  reading,  spelling,  number 
and  writing).  He  will  likewise  be  better  prepared  for  his 
work  if  he  has  taught  educational  psychology  or  the  prin- 
ciples of  teaching  in  training  schools  for  teachers,  so  that 
he  is  alive  to  the  vital  educational  problems  concerning 
pedagogical  methodology  (questions  regarding  methods  of 
studying,  learning,  instructing,  drilling,  memorizing, 
initiative,  working  efficiency,  hours,  rests,  alternation 
of  subjects,  etc.)  and  so  that  he  may  thus  turn  his  investi- 
gations to  wider  pedagogical  use. 

5.  He  must  have  made  a  very  exhaustive  study  of  all 
phases  of  corrective  pedagogics.     He  must  be  thoroughly 


NEW  CLINICAL  PSYCHOLOGY  117 

grounded  in  the  differential  pedagogy  which  applies  to  the 
types  of  cases  he  expects  to  handle. 

This  may  seem  like  an  extremely  exacting  course  of 
training  but  it  is  not  more  exacting  than  the  training  now 
demanded  of  the  various  medical  specialists  and  it  will 
certainly  only  make  a  reasonable  demand  on  the  time  of 
the  student  who  from  the  outset — at  least  from  the  bacca- 
laureate— shapes  his  work  towards  the  career  of  a  psycho- 
educational  examiner.  Certainly  the  work  is  so  varied, 
complex  and  technical  that  complete  mastery  is  out  of 
the  question  without  three  or  four  years  of  preparation. 
Eventually  the  well-trained  specialist  in  this  field  must 
command  the  respect  and  the  emoluments  accorded  to  the 
specialist  in  the  allied  medical  fields. 


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BoEHNE.      Special    Classes    in    the    Rochester    Schools. 
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118    MENTAL  HEALTH  OF  SCHOOL  CHILD 

1913,  38:  555f.  See  also  the  statistical  study  of  Abbot, 
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8.  Gayler.  Retardation  and  Elimination  in  Graded  and 
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9.  Gayler.  A  Further  Study  of  Retardation  in  Illinois. 
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De  Sanctis  Tests  and  the  Binet  and  Simon  Tests  of 
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11.  GoDDARD.  Binet's  Measuring  Scale  for  Intelligence.  The 
Training  School,  1910,  6:  No.  11.  Revised  edition, 
1911. 

12.  GoDDARD.  Two  Thousand  Normal  Children  Measured 
by  the  Binet  Measuring  Scale  of  Intelligence.  Peda- 
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13.  GuLicK.  Causes  of  Dropping  Out  of  School.  World's 
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more, 1912. 

15.  HuEY.  The  Present  Status  of  the  Binet  Scale  of  Tests 
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16.  J.  Progress  and  Retardation  of  a  Baltimore  Class. 
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17.  Jones.  Psycho-analysis  in  Psychotherapy.  Montreal 
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18.  KuHLMANN.  Binet  and  Simon's  System  for  Measuring 
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19.  KuHLMANN.  The  Present  Status  of  the  Binet  and  Simon 
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Asthenics,  1912,  16:  No.  3. 


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23.  MuNSTERBERG.  On  the  Witness  Stand,  Essays  on  Psy- 
chology and  Crime.     New  York,  1908. 

24.  MuNSTERBERG.     Psychothcrapy.     New  York,  1909. 

25.  MuNSTERBERG.  Psychology  and  Industrial  Efficiency. 
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26.  ScHMiTT.  Retardation  Statistics  of  Three  Chicago 
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27.  Taylor.  The  Widening  Sphere  of  Medicine.  The  Har- 
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Mauch  Chunk  Township,  Pennsylvania.  The  Psycho- 
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31.  Wallin.  Experimental  Studies  of  Mental  Defectives. 
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33.  Whipple.  Manual  of  Mental  and  Physical  Tests.  Balti- 
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of  children.) 


120    MENTAL  HEALTH  OF  SCHOOL  CHILD 

34.  Wither.  Clinical  Psychology.  The  Psychological 
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Groszmann.  The  Study  of  Individual  Children.  Plainfield, 
1912. 

Holmes  (Arthur).  The  Conservation  of  the  Child.  Phila- 
delphia, 1912. 

Holmes  (W.  H.).  School  Organization  and  the  Individual 
Child.    Worcester,  1912. 

WiTMER  (and  others).  The  Special  Class  for  Backward  Chil- 
dren.    Philadelphia,  1911. 


CHAPTER  III 

CLINICAL  PSYCHOLOGY:  WHAT  IT  IS  AND 
WHAT  IT  IS  NOT^ 

On  an  occasion  like  this"  it  would  seem  proper,  repre- 
senting as  I  do  one  of  the  newest  of  the  sciences,  that  I 
address  myself  to  some  of  the  basic  questions  of  this  science. 
Perhaps  the  very  first  question  with  which  one  is  con- 
fronted is  simply  this :  'In  view  of  the  rapid  multiplication 
of  the  sciences,  by  what  right  does  clinical  psychology  lay 
claim  to  an  independent  existence?'  That  is  a  question 
which  may  perturb  some  sensitive  minds,  but  it  does  not 
disconcert  the  clinical  psychologist,   for   he   regards   the 

1  Reprinted  from  Science,  1913,  pp.  895-902. 

2  Substance  of  an  address  delivered  before  the  Conference  on  the 
Exceptional  Child,  held  under  the  auspices  of  the  University  of  Pitts- 
burgh, April  16,  1912.  Lest  misapprehensions  arise,  it  should  be 
clearly  understood  that  in  this  discussion  I  am  concerned  only  with 
the  relation  of  clinical  psychology  to  mentally  exceptional  school  chil- 
dren; and  that  I  distinctly  recognize  a  different  type  of  exceptional 
children,  namely,  the  physical  defectives.  The  physical  defectives 
should  be  examined  by  skilled  pediatricians.  The  clinical  psychologist 
is  interested  in  physically  exceptional  children  when  they  manifest 
mental  deviations.  Moreover,  while  I  hold  that  the  psycho-clinical 
laboratories  must  become  the  clearing  houses  for  all  types  of 
mentally  or  educationally  exceptional  children  in  the  schools,  nearly 
all  mentally  exceptional  children  should  be  given  a  prior  physical 
examination  by  consulting  or  associated  medical  experts.  Physical 
abnormalities  should,  of  course,  be  rectified,  whether  or  not  it  can  be 
shown  that  they  sustain  any  causal  relation  to  the  mental  deviations 
which  may  have  been  disclosed  in  the  psycho-clinical  examination. 
They  should  claim  treatment  in  their  own  right. 


122    MENTAL  HEALTH  OF  SCHOOL  CHILD 

question    as    perfectly    legitimate    and   capable    of    satis- 
factory answer. 

It  is  just  and  proper  that  a  new  claimant  to  membership 
in  the  family  of  sciences  should  be  required  to  present  her 
credentials.  It  is  a  natural  human  trait  to  challenge  or 
contest  the  claims  of  a  newcomer.  It  has  ever  been  thus. 
Every  branch  of  knowledge  before  winning  recognition  as 
an  independent  science  has  been  forced  to  demonstrate  that 
it  possesses  a  distinct  and  unique  body  of  facts  not  ade- 
quately treated  by  any  other  existing  science;  or  that  it 
approaches  the  study  of  a  common  body  of  facts  from  a 
unique  point  of  view,  and  with  methods  of  its  own.  Psy- 
chology, bio-chemistry,  dentistry,  eugenics,  historiometry 
and  many  other  sciences  have  been  thus  obliged  to  fight 
their  way  inch  by  inch  to  recognition  as  independent 
sciences.  It  is  not  long  since  physiology  claimed  psy- 
chology as  its  own  child  and  stoutly  contested  her  rights  to 
existence ;  nor  is  it  long  since  medicine  denied  any  right  to 
independent  existence  to  dentistry.  It  is  no  surprise  that 
a  number  of  sciences  now  claim  clinical  psychology  as  part 
and  parcel  of  their  own  flesh  and  blood,  and  that  they 
deny  her  the  right  to  'split  off  from  the  parent  cell'  and 
establish  an  unnursed  existence  of  her  own.  Just  as  nature 
abhors  a  vacuum,  so  science  abhors  the  multipHcation  of 
sciences;  just  as  the  big  corporation  octopus  in  the  indus- 
trial world  tries  to  get  monopolistic  control  of  the  sources 
of  production  and  distribution,  so  the  various  sciences, 
naturally  insatiable  in  their  desire  for  conquest,  attempt 
only  too  often  to  get  monopolistic  control  of  all  those 
elements  of  knowledge  which  they  may  be  able  to  use  for 
their  own  aggrandizement,  whether  or  not  they  have  devel- 
oped adequate  instruments  for  scientifically  handling  those 
elements. 


CLINICAL  PSYCHOLOGY  123 

Clinical  psychology,  however,  is  quite  ready  to  contest 
the  attempts  to  deprive  her  of  her  inalienable  rights  to  the 
'pursuit  of  life  and  happiness.'  Fundamentally,  she  bases 
her  claims  to  recognition  as  an  independent  science  on  the 
fact  that  she  does  possess  a  unique  body  of  facts  not  ade- 
quately handled  by  any  existing  science,  and  that  she 
investigates  these  facts  by  methods  of  her  own.  These 
facts  consist  of  individual  mental  variations,  or  the  phe- 
nomena of  deviating  or  exceptional  mentality.  In  other 
words,  chnical  psychology  is  concerned  with  the  concrete 
study  and  examination  of  the  behavior  of  the  mentally 
exceptional  individual  (not  groups),  by  its  own  methods  of 
observation,  testing  and  experiment. 

In  the  study  or  examination  of  individual  cases,  the 
clinical  psychologist  seeks  to  realize  four  fundamental 
aims: 

1.  An  adequate  diagnosis  or  classification.  He 
attempts  to  give  a  correct  description  of  the  nature  of  the 
mental  deviations  shown  by  his  cases ;  he  tries  to  deter- 
mine whether  they  are  specific  or  general,  whether  they 
affect  native  or  acquired  traits ;  he  attempts  to  measure 
by  standard  objective  tests  the  degree  of  de^'iation  of 
various  mental  traits  or  of  the  general  level  of  functioning ; 
he  seeks  to  arrive  at  a  comprehensive  clinical  picture,  to 
disentangle  symptom-complexes  and  to  reduce  the  disorders 
to  various  reaction  types. 

2.  An  analysis  of  the  etiological  background.  His 
examination  is  bent  not  only  on  determining  the  present 
mental  status  of  the  case,  but  on  discovering  the  causative 
factors  or  agents  which  have  produced  the  deviations — - 
whether  these  factors  are  physical,  mental,  social,  moral, 
educational,  environmental  or  hereditary.  In  order  to 
arrive  at  a  correct  etiology,  the  psycho-chnician  makes  not 


124    MENTAL  HEALTH  OF  SCHOOL  CHILD 

only  a  cross-section  analysis  of  the  case,  but  also  a  longi- 
tudinal study  of  the  evolution  of  the  deviation  or  symptom- 
complex.  Therefore,  he  does  not  limit  himself  merely  to  a 
psychological  examination,  but  requires  a  dento-medical 
examination  and  a  pedagogical,  sociological  and  heredi- 
tary examination.  The  physical  examination  should  be 
made  by  experts  in  dentistry  and  in  the  various  specialties 
in  the  field  of  medicine.  The  psycho-chnicist,  however, 
should  be  so  trained  in  physical  diagnosis  that  he  can 
detect  the  chief  physical  disorders,  so  that  he  can  properly 
refer  his  cases  for  expert  physical  examination. 

3.  A  determination  of  the  modification  which  the  dis- 
order has  wrought  in  the  behavior  of  the  individual.  He 
should  determine  what  its  consequences  have  been :  what 
effects  it  has  had  upon  his  opinions,  beliefs,  thoughts,  dis- 
position, attitudes,  interests,  habits,  conduct,  capacity  for 
adaptation,  learning  ability,  capacity  to  acquire  certain 
kinds  of  knowledge  or  various  accomplishments,  or  to  do 
certain  kinds  of  school  work.  He  should  seek  to  locate 
the  conflicts  between  instincts  and  habits  which  may  have 
been  caused  by  the  deviations. 

4.  The  determination  of  the  degree  of  modifiahility 
of  the  variations  discovered.  Can  the  deviations  be  cor- 
rected or  modified,  and  if  so  to  what  extent  and  by  what 
kinds  of  orthogenic  measures  .f"  A  clinical  ps3^chologist  is 
no  less  a  scientific  investigator  than  a  consulting  special- 
ist ;  he  diagnoses  in  order  to  prognose  and  prescribe.  His 
aim,  first  and  last,  is  eminently  practical. 

Basis  of  Selection  of  Cases 

The  clinical  psychologist  selects  his  cases  not  so  much 
on  the  nature  of  the  cause  of  the  deviations  (whether 
social,  hereditary,  physical,  pedagogical  or  psychological) 


CLINICAL  PSYCHOLOGY  125 

as  on  the  nature  of  the  deviations  themselves,  and  the 
nature  of  the  treatment.  He  is  interested  in  cases  wliich, 
first  of  all,  depart  from  the  limits  of  mental  normahty. 
Exceptional  mentality,  or,  if  you  please,  mental  exception- 
ality is  his  first  criterion.  In  the  second  place,  he  is  inter- 
ested in  those  cases  in  which  the  nature  of  the  treatment — 
the  process  of  righting  the  mental  variations,  of  straight- 
ening out  the  deviations,  the  orthogenesis — is  wholly  or 
chiefly  or  partly  educational.  In  the  term  educational  I 
include  training  of  a  hygienic,  physiological  (in  Seguin's 
sense),  pedagogical,  psychological,  sociological  or  moral 
character. 

Grouping  of  Cases 

It  is  thus  evident  that  the  clinical  psychologist  may 
group  his  cases  into  two  main  classes, 

A.  Those  in  which  the  mental  variations  are  funda- 
mental or  primary,  and  the  physical  disabilities  only  acces- 
sory or  sequential.  With  these  cases  the  treatment  must 
be  primarily  educational  and  only  secondarily  medical. 
What  types  of  children  are  included  in  this  group  ? 

1.  Feeble-minded  children.  Feeble-mindedness  for- 
merly was  regarded  as  an  active  disorder — a  disease — and 
was  accordingly  treated  exclusively  medically.  The  theory 
of  causation  was  wrong  and  so  the  results  were  unsatis- 
factory. Since  the  year  1800  (Itard,  the  apostle  to  the 
feeble-minded)  and  particularly  since  the  year  1837 
(Seguin,  the  liberator  of  the  feeble-minded),  it  has  become 
increasingly  apparent  that  feeble-mindedness  is  an  arrest 
of  development ;  and  accordingly  since  that  time  the  condi- 
tion has  primarily  been  treated  educationally  instead  of 
medically.    This  change  in  point  of  view  has  revolutionized 


126    MENTAL  HEALTH  OF  SCHOOL  CHILD 

the  treatment  of  the  feeble-minded.  The  person  who  did 
most  to  amehorate  their  condition  is  Seguin,  whose  method, 
almost  entirely  educational,  has  served  as  the  model  for  the 
effective  institutional  work  for  the  feeble-minded  done  since 
his  day,  although  we  have  outgrown  various  details  of  his 
system.  Moreover,  it  served  as  the  chief  inspiring  force 
for  the  constructive  orthogenic  work  done  for  the  feeble- 
minded within  the  last  decade  or  so  by  Montessori.  She, 
herself  a  physician,  but  with  special  training  in  psychology 
and  pedagogy,  tells  us  that  in  1898,  as  a  result  of  a  careful 
study  of  the  problem  of  feeble-mindedness  she  became  per- 
suaded that  the  problem  was  primarily  a  pedagogical  and 
not  a  medical  one.  It  is  granted  without  question,  of  course, 
that  there  is  a  medical  side  to  the  care  of  the  feeble-minded 
just  as  there  is  a  medical  side  to  the  care  of  the  normal 
child.  Nay,  owing  to  the  heightened  degree  of  suscepti- 
bility to  disease  and  accidents  found  among  the  feeble- 
minded, the  medical  side  looms  larger  in  the  care  of  the 
feeble-minded  than  in  the  care  of  normals.  Indeed,  no 
institution  for  the  feeble-minded  can  be  properly  organized 
without  an  adequate  staff  of  medical  experts ;  but  funda- 
mentally the  problem  of  ameliorating  the  sad  lot  of 
feeble-minded  children  is  an  educational  one — their 
hygienic,  pedagogical  and  moral  improvement,  as  well  as 
their  ehmination  by  the  method  of  colonization  or  sterili- 
zation. 

2.  Retardates,  technically  so-called — of  which  there 
are  probably  on  a  conservative  estimate  6,000,000  in  the 
schools  of  the  United  States.  Some  of  these  are  retarded 
(1)  merely  pedagogically  in  a  relative  sense — relative  to 
an  arbitrary  curricular  standard.  Many  children  do  not 
fit  the  standard,  because  the  standard  itself  is  off  the 
norm.     It  is  largely  a  case  of  a  misfit  curriculum  instead 


CLINICAL  PSYCHOLOGY  127 

of  a  misfit  child.  So  far  as  this  class  of  misfits  is  con- 
cerned, the  problem  is  simply  one  of  correct  adjustment  of 
the  pedagogical  demands  of  the  curriculum. 

A  considerable  percentage  of  the  retardates,  however, 
are  retarded  because  of  (2)  genuine  mental  arrest  of 
development.  They  are  as  truly  arrested  or  deficient  as 
the  feeble-minded,  but  to  a  lesser  extent.  The  difference 
is  a  quantitative  and  not  a  qualitative  one,  and  the  prob- 
lem of  correction  consists  fundamentally  in  providing  a 
right  educational  regimen. 

Then  there  is  (3)  a  smaller  proportion  of  retardates 
who  are  mentally  retarded  because  of  environmental  handi- 
caps, such  as  bad  housing,  home  and  neighborhood  condi- 
tions, bad  sanitation,  lack  of  humidity,  lack  of  pure  air 
or  excessive  temperature  in  the  schoolroom,  vicious  or 
illiterate  surroundings,  frequent  moving  or  transfer,  emi- 
gration which  may  cause  linguistic  maladaptation,  etc. 
With  such  retardates  the  problem  is  partly  sociological, 
partly  hygienic  and  partly  pedagogical. 

We  have  a  final  group  of  children  (4)  who  are  mentally 
retarded  because  of  some  physical  defect.  With  children 
of  this  type  the  problem  is  partly  medical  and  partly 
educational.  The  first  efforts  made  in  behalf  of  such 
children  should  be  medical  and  hygienic.  Undoubtedly  the 
removal  of  physical  handicaps  will  restore  some  pupils  to 
normal  mentality,  while  in  the  case  of  other  pupils  the 
results  will  be  negative.  Unfortunately  many  of  the 
studies  in  this  field  (see  Chapter  XV)  have  a  questionable 
value  because  of  the  obvious,  but  evidently  unconscious 
bias  of  the  investigators.  Some  desire  to  show  favorable 
results  and,  therefore,  unconsciously  select  only  the  favor- 
able cases ;  others  are  swayed  by  the  opposite  motive  and 


128    MENTAL  HEALTH  OF  SCHOOL  CHILD 

accordingly  tend  to  select  the  negative  cases.  Hence,  at 
the  present  time  we  find  considerable  diversity  of  opinion 
as  to  the  orthogenic  influences  of  the  correction  of  physical 
disorders.  The  opinion  of  John  J.  Cronin,  M.D.,  probably 
approximates  the  truth : 

The  successes  simply  mean  that  a  large  number  of  children 

were  perfect  except  for  some  one  abnormality The 

alleviation  of  any  single  kind  of  physical  handicap  is  merely 
one  step  towards  the  successful  result  sought,  and  many  other 
factors  must  obtain  before  some  measure  of  success  is  assured. 

Likewise  A.  Emil  Schmitt,  M.D. : 

It  should  constantly  be  borne  in  mind  that  if  every  physical 
defect  has  been  successfully  removed  the  mental  unbalance  or 
deficiency  can  remain  unaltered,  inasmuch  as  it  was  primarily  a 
mental  defect  and  can  be  reached  only  by  methods  of  educa- 
tion or  psychological  treatment. 

While  I  am  quite  convinced  that  all  mentally  retarded 
children  should  undergo  a  careful  physical  examination, 
and  that  such  physical  corrective  measures  should  be 
applied  as  are  indicated  by  expert  medical  opinion,  yet  it 
needs  to  be  reemphasized  that  the  removal  of  a  physical 
disability  is  frequently  only  the  first  step  toward  restora- 
tion. If  the  child  has  fallen  behind  pedagogically  or 
mentally,  he  will  in  many  cases  need  special  pedagogical 
attention  if  he  is  to  catch  step  with  the  class  procession; 
moreover,  after  a  certain  critical  age  has  been  passed,  the 
removal  of  physical  obstructions  exercises  only  a  slight 
orthophrenic  influence,  and  the  reestablishment  of  eff'ective 
mental  functioning,  if  it  can  be  done  at  all,  will  require  the 
prolonged  application  of  a  special  corrective  pedagogy. 

3.  The  super  normals.  Both  of  the  above  types  of 
children  come  on  the  minus  side  of  the  curve  of  efficiency. 


CLINICAL  PSYCHOLOGY  129 

On  the  other  side  we  find  the  plus  deviates — the  bright, 
brilliant,  quick,  gifted,  talented,  precocious  children. 
These  children  may  present  no  peculiarities  on  the  physi- 
cal side,  if  we  except  the  type  of  nervously  unstable,  pre- 
cocious children.  With  the  healthy  supernormal  child  the 
problem  is  almost  entirely  an  educational  one:  the  intro- 
duction of  schemes  of  flexible  grading;  of  fast,  slow  and 
normal  sections,  and  of  supernormal  classes ;  providing 
special  opportunities  for  doing  specialized  work,  and  a 
special  pedagogy,  which  should  probably  be  as  largely 
negative  as  positive.  If  there  is  any  one  child  in  our 
scheme  of  public  education  which  has  been  neglected  more 
than  any  other,  it  is  the  child  of  unusual  talents.  A  nation 
can  do  no  higher  duty  by  its  subjects  than  to  provide  those 
conditions  which  will  rescue  its  incipient  geniuses  from  the 
dead-level  of  enforced  mediocrity. 

4.  Speech  defectives,  particularly  the  2  per  cent 
(approximately)  of  stutterers  and  hspers  who  encumber 
our  classes.  In  few  fields  of  scientific  research  is  it  possible 
to  find  such  astonishing  diversity  of  so-called  expert 
opinion  as  on  the  question  of  the  causation  of  stuttering 
(or  stammering).  It  is  claimed  to  be  a  gastric,  pneumo- 
gastric,  lung,  throat,  lip,  brain,  hypoplastic,  nervous  and 
mental  disorder.  It  is  said  to  be  a  form  of  epilepsy,  a 
form  of  hysteria  and  a  form  of  mental  strife,  or  repression, 
between  latent  and  manifest  mental  contents.  Moreover, 
few  writers  show  such  a  consummate  genius  for  self-con- 
tradiction as  writers  on  stuttering.  Before  me  lies  a 
reprint  of  a  recent  dissertation  on  the  'Educational  Treat- 
ment of  Stuttering  Children.'  The  writer  begins  by  saying 
that  stuttering  is  a  'pathological  condition,'  a  disease,  and 
that,  therefore,  its  treatment  belongs  to  a  specialist  on  dis- 
eases.    The  disease  appears,  however,  on  the  second  page 


130    MENTAL  HEALTH  OF  SCHOOL  CHILD 

to  be  merely  'a  purely  functional  neurosis,'  while  on  the 
last  page  the  trouble  is  nothing  more  than  a  'mental  one,' 
caused  by  influences  acting  on  the  mind.  As  a  matter  of 
fact,  the  treatment  which  the  writer  recommends  is, 
through  and  through,  educational  and  largely  psychologi- 
cal. It  consists  of  certain  physical  exercises,  designed  not 
so  much  to  strengthen  certain  organs  as  to  win  the 
patient's  interest  and  restore  his  self-confidence;  and 
certain  psycho-therapeutic  and  hypnotic  exercises. 

Waiving  for  the  time  being  the  nature  of  the  cause,  we 
can  agree  on  one  thing;  namely,  that  the  methods  of 
treating  stuttering  (and  lisping)  which  have  been  proved 
effective  are  almost  exclusively  educational.  Many  of  the 
neurotic  symptoms  ('functional  neuroses')  found  in  the 
stutterer  are  the  results  of  mental  tension  and  will  dis- 
appear with  the  correction  of  the  stuttering. 

5.  Incipient  psychotics,  or  children  who  show  develop- 
mental symptoms  of  mental  disorders  or  mental  alienation. 
Here  we  meet  with  the  same  controversy  between  the  advo- 
cates, on  the  one  hand,  of  a  somatogenic  theory,  and,  on 
the  other  hand,  of  a  psychogenic  theory  of  causation. 
While  it  must  be  admitted  that  many  of  the  psychoses  are 
certainly  organic,  others  almost  as  certainly  are  functional 
and  are  produced  by  idiogenic  factors  (a  view  entertained 
by  such  well-known  psycliiatrists  as  Meyer,  Freud,  Janet, 
Dubois,  Jones,  Prince).  Now,  irrespective  of  whether  the 
cause  is  chiefly  physical  or  mental,  it  is  being  recognized 
by  a  number  of  the  leading  present-day  psychiatrists  that 
drug  treatment  for  the  majority  of  the  insane,  whether 
juvenile  or  adult,  is  secondary  to  the  educational  treat- 
ment. Instead  of  merely  prescribing  physical  hygiene  for 
the  insane,  leading  alienists  are  now  prescribing  mental 
hygiene.      The    cure    is    being    conceived   in    terms    of    a 


CLINICAL  PSYCHOLOGY  131 

process  of  reeducation.  Moreover,  so  far  as  concerns  the 
mentally  unstable  child  in  the  schools,  the  chief  reliance  is 
obviously  on  hygienic  and  educational  guidance. 

B.  Cases  in  which  the  physical  deviations  are  -funda- 
mental or  primary,  and  the  mental  variations  sequential, 
but  the  remedy  partly  or  chiefly  educational.  Here  we 
include  malnutrition,  rickets,  marasmus,  hypothyroidism, 
tuberculosis,  heart  trouble,  chorea  and  similar  diseases. 
In  all  of  these  the  treatment  must  be  primarily  medical, 
although  there  should  be  a  special  temporary  educational 
regimen  for  these  children.  This  group  also  includes  the 
blind  and  the  deaf.  But  here  the  treatment  is  almost 
wholly  educational.  The  physical  defects  are  incurable, 
but  the  mental  defects  can  be  partly  overcome  by  proper 
compensatory  educational  treatment.  The  epileptic  also 
must  be  added  to  this  group.  Epilepsy  is  evidently  an 
active  disorder  or  disease  process,  although  the  pathology 
is  wrapped  in  the  deepest  obscurity.  The  epileptics  appear 
like  purely  medical  cases.  The  medical  aspect  certainly  is 
important,  but  the  records  show  that  only  from  5  to  10 
per  cent  are  curable,  and  that  the  attacks  can  be  as 
readily  modified  or  regulated  in  most  cases  by  proper 
hygienic  treatment  as  by  drug  medication  or  surgical 
interference.     To  quote  Montessori : 

Benedickt^  and  following  him,  the  principal  authorities 
among  m.edical  specialists,  are  at  present  condemning  the  use 
of  depressing  bromides,  which  hide  the  attacks  as  an  anes- 
thetic hides  pain,  but  do  not  cure  them.  The  cure,  says  Bene- 
dickt,  depends  upon  hygienic  life  in  the  open  in  order  to 
absorb  the  poisons,  and  upon  work,  rationally  measured  and 
graded,  provided,  however,  that  the  malady  is  still  recent  and 
has  not  assumed  a  chronic  form.  The  treatment  consists  in 
educating  them. 


132    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Even  with  these  unfortunates,  it  can  be  said  that  the  best 
results  come  from  a  proper  medico-educational  regime — 
colonization,  outdoor  employment,  industrial  schooling, 
bathing,  etc. 

Summary  of  Important  Conclusions 

We  are  thus  brought  to  the  two  following  conclusions : 

1.  There  is  a  set  of  unique  facts — facts  of  individual 
mental  variation — which  no  existing  science  has  adequately 
treated.  It  is  with  these  facts  that  the  work  of  the  clinical 
psychologist  is  concerned.  Just  as  psychology  became  an 
independent  science  by  demonstrating  that  it  possessed  a 
legitimate  claim  to  a  unique  world  of  facts,  so  clinical  psy- 
chology is  ready  to  make  her  declaration  of  independence 
and  dedicate  herself  to  the  investigation  of  a  body  of 
facts — facts  of  individual  mental  variation — not  hitherto 
adequately  handled  by  any  existing  science.  It  is  con- 
cerned with  the  study  of  individual  cases  of  deviate  men- 
tahty,  particularly  with  those  types  which  are  amenable  to 
improvement  or  correction  by  psycho-educational  pro- 
cesses. 

2.  The  proper  handling  of  these  cases,  whether  for 
purposes  of  examination,  recommendation  or  prescription, 
can  only  be  done  by  a  psycho-educational  specialist  who 
possesses  the  training  indicated  in  Chapter  II. 

The  Relations  of  Clinical,  Psychology — Some 
Affirmations  and  Denials 

There  are  a  number  of  sciences  with  which  clinical  psy- 
chology is,  will  be  or  should  be  closely  related,  but  which 
are  not  synonymous  with  clinical  psychology. 

1.     Clinical  psychology  is  not  the  same  as  psychiatry 


CLINICAL  PSYCHOLOGY  133 

(and  psychopathology) .  The  typical  alienist  is  concerned 
with  the  study  and  treatment  of  mental  disorders  (tech- 
nically called  psychoses)  ;  the  clinical  psychologist,  on  the 
other  hand,  is  concerned  particularly  (though  not  solely) 
with  the  study  of  plus  and  minus  deviations  from  normal 
mentality.  The  alienist  works  chiefly  with  adults,  the 
clinical  psychologist  with  children.  Few  alienists  possess 
any  expert  knowledge  of  the  literature  bearing  on  child  or 
educational  psychology,  mental  deficiency,  retardation  or 
acceleration,  stuttering  or  lisping,  special  pedagogy  or 
psycho-clinical  methods  of  testing.  An  alienist  accord- 
ingly is  not  to  be  considered  a  specialist  on  the  mentally 
exceptional  child  in  the  schools  unless,  indeed,  he  has  sup- 
plemented his  general  medical  and  psychiatric  education 
with  a  technical  study  of  the  psychological  and  educational 
aspects  of  the  problem.  The  alienist  of  the  future  will 
certainly  have  to  secure  a  different  preparation  from  that 
now  furnished  in  the  medical  schools,  if  he  is  to  enter  the 
field  of  pedagogic  child  study. 

Before  me  lies  the  report  of  the  department  of  medical 
inspection  of  a  large  school  system.  Six  hundred  retarded 
children  were  examined  in  this  department,  which  is  in 
charge  of  an  alienist,  who,  as  I  am  told,  is  an  expert  on 
the  questions  of  adult  insanity,  but  who  has  no  specialized 
preparation  in  the  psychology  and  pedagogy  of  the  men- 
tally defective  child.  Of  these  children  49.7  per  cent  are 
recorded  as  feeble-minded.  Applying  this  figure  to  the 
6,000,000  retardates  of  the  public  schools  of  the  country, 
we  get  a  total  feeble-minded  school  population  of  3,000,- 
000.  This  figure,  it  need  scarcely  be  said,  is  monstrously 
absurd.  It  is  fully  ten  times  too  large.  Feeble-mindedness 
and  backwardness  in  children,  it  must  be  said,  are  distinct 
problems   from   mental  alienation,   and   require   for   their 


134    MENTAL  HEALTH  OF  SCHOOL  CHILD 

satisfactory  handling  a  specialist  on  mentally  deviating 
children.  A  high-grade  feeble-minded  cliild  can  not  be 
identified  merely  by  some  rule-of-thumb  system  of  intelli- 
gence tests.  Feeble-mindedness  involves  more  than  a  given 
degree  of  intelligence  retardation.  At  the  same  time,  lest 
I  be  misunderstood,  it  should  be  specially  stated  that  psy- 
chiatry and  clinical  psychology  will  be  mutually  helped  by 
a  closer  union.  Clinical  psychology  has  many  important 
facts  and  a  valuable  experimental  technique  to  offer  to 
psychopathology,  and  psychopathology  in  turn  is  able 
to  contribute  facts  of  great  value,  and  more  particularly 
an  effective  clinical  method  of  examination,  to  clinical  psy- 
chology. As  the  idiogenic  conception  of  the  causation  of 
various  psychoses  wins  greater  recognition,  clinical  psy- 
chology will  become  more  and  more  indispensable  to  the 
psychiatrist  and  psychopathologist.  It  is  also  certain 
that  the  efficiency  of  the  clinical  psychologist  will  be 
greatly  increased  by  a  study  of  mental  alienation — not  a 
study  of  texts  on  psychiatry,  but  a  first-hand  study  in  in- 
stitutional residence  of  individual  cases.  Any  one  intend- 
ing to  do  psycho-clinical  work  with  mentally  deficient 
children  certainly  should  spend  at  least  a  year  or  two  in 
residence  at  institutions  for  feeble-minded,  epileptic  and 
alienated  children.  The  clinical  psychologist  should  be 
prepared  to  recognize  cases  of  incipient  mental  disorder, 
so  that  he  will  be  enabled  to  select  these  cases  and 
refer  them  to  a  psycliiatric  or  psychopathic  specialist  for 
further  examination. 

2.  Clinical  psychology  is  not  neurology.  There  are 
important  neurological  aspects  involved  in  the  study  of 
mentally  exceptional  children.  Mental  arrest  can  be 
largely  expressed  in  terms  of  neurological  arrest,  and  a 
clinical  psychologist  should  have  a  first-hand  knowledge  of 


CLINICAL  PSYCHOLOGY  135 

nerve  signs  and  a  practical  acquaintance  with  the  methods 
of  neurological  diagnosis.  His  knowledge  of  neurology 
should  be  sufficient  to  enable  him  to  pick  out  suspected 
nervous  cases  and  refer  them  for  expert  examination  by  a 
neurologist.  However,  it  must  be  emphasized  that  neurol- 
ogy touches  only  one  side — though  an  extremely  important 
side — of  the  problem  of  exceptional  mentality. 

3.  Clinical  psychology  is  not  synonymous  with  general 
medicine.  The  average  medical  practitioner  certainly 
knows  far  less  about  the  facts  of  mental  variation  in  chil- 
dren than  either  the  psychiatrist  or  neurologist  or  even 
the  classroom  teacher.  This  fact  should  occasion  no  sur- 
prise when  it  is  stated  that  the  study  of  psychology  as  a 
science  has  been  practically  ignored  in  medical  curri- 
cula throughout  the  country.  The  clinical  psychologist, 
however,  as  I  have  already  said,  should  be  able  to  detect 
the  chief  physical  defects  found  in  school  children,  so  that 
if  the  laboratory  of  the  clinical  psychologist  assumes  the 
function  of  a  clearing  house  for  the  exceptional  child  he 
may  be  able  to  refer  all  suspected  medical  cases  to  proper 
medical  clinics  for  expert  examination  and  treatment. 

4.  Clinical  psychology  is  not  pediatrics.  To  be  sure, 
the  pediatrician  deals  with  children.  But  his  attention  is 
focused  on  the  physical  abnormalities  of  infants  ;  his  inter- 
est in  the  phenomena  of  mental  exceptionality  is  liable  to 
be  incidental  or  perfunctory.  In  fact,  one  may  read  some 
texts  on  pediatrics  from  cover  to  cover  without  so  much 
as  arriving  at  a  suspicion  that  there  is  a  body  of  unique 
facts  converging  on  the  phenomena  of  departure  from  the 
limits  of  mental  normality  which  require  intensive,  special- 
ized, expert  study  and  diagnosis.  So  far  as  the  physical 
ailments  or  disabilities  of  young  children  are  concerned  the 
pediatrician  is  in  a  position  to  render  valuable  service  to 


136    MENTAL  HEALTH  OF  SCHOOL  CHILD 

the  psycho-clinicist ;  likewise  so  far  as  concerns  the  mental 
deviations  of  children  the  psycho-clinicist  is  able  to  render 
valuable  aid  to  the  pediatrician.  But  one  must  not  confuse 
pediatrics  with  clinical  psychology. 

5.  Clinical  psychology  is  not  the  same  as  introspective, 
educational  or  experimental  psychology.  It  differs  from 
these  in  its  method,  standpoint  and  conceptions.  While 
the  clinical  psychologist  should  be  grounded  in  introspec- 
tive and,  especially,  experimental,  educational  and  child 
psychology,  expertness  in  these  branches  of  psychology 
does  not  in  itself  confer  expertness  in  practical  psycho- 
clinical  work.  Such  expertness  comes  only  from  a  technical 
training  in  clinical  psychology  and  from  a  first-hand  pro- 
longed study  by  observation,  or  experiment,  or  test  of 
various  kinds  of  mentally  exceptional  children,  particu- 
larly the  feeble-minded,  the  psychopathic,  the  epileptic 
and  the  retarded.  The  skilled  specialist  in  experimental 
or  educational  psychology  or  experimental  pedagogy  is 
no  more  qualified  to  clinically  examine  mental  cases,  than 
is  the  skilled  zoologist,  physiologist  or  anatomist  able  to 
clinically  examine  physical  cases.  Clinical  work,  both  in 
psychology  and  medicine,  requires  clinical  training.  The 
assumption  that  any  psychologist  or  educationist  (and, 
forsooth,  any  physician  or  medical  inspector)  is  qualified 
to  do  successful  psycho-clinical  work,  after  learning  how 
to  administer  a  few  mental  tests,  is  preposterous  and 
fraught  with  the  gravest  consequences.  Clinical  psychol- 
ogy can  have  no  standing  in  the  professions  as  long  as  we 
permit  this  absurd  notion  to  prevail. 


CHAPTER  IV 

THE  FUNCTIONS  OF  THE  PSYCHOLOGICAL 
CLINIC 

The  psychological  clinic  is  a  very  modern  American 
creation.  The  first  chnic  was  started  in  a  small  way  only 
eighteen  years  ago  in  the  University  of  Pennsylvania. 
The  growth  of  these  clinics  was  at  first  very  slow,  but 
during  the  last  three  or  four  years  they  have  rapidly  mul- 
tiplied (see  statistics  in  Chapters  II  and  XVIII).  Besides 
the  clinical  psychologists  there  are  a  considerable  number 
of  teachers,  nurses,  physicians  and  others  who  are  tyros  or 
amateurs  in  psychology  and  psycho-educational  thera- 
peutics, who  are  testing  children  in  schools,  juvenile  courts 
and  institutions,  but  the  work  of  most  of  these  amateurs 
can  scarcely  be  considered  in  speaking  of  clinical  psychol- 
ogy or  of  psycho-clinical  technicians.  Professor  O'Shea 
has  recently  predicted  (School  Review,  April,  1913,  p. 
285)  that  within  a  decade  there  will  be  a  psychological 
clinic  in  every  community  with  2,500  or  more  school  chil- 
dren. That  may  be  so  if  we  agree  to  call  any  place  in 
which  mental  tests  may  be  given  a  'psychological  clinic' 
The  psychologist,  however,  would  probably  just  as  strenu- 
ously object  to  having  these  testing  stations  called  'psy- 
chological clinics'  as  the  psychiatrists  would  object  to 
having  them  called  'psychiatric  chnics.' 

1  Reprinted,  with  alterations  and  additions,  from  The  Medical 
Record,  September  20,  1913. 


138    MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  development  of  the  psychological  chnic  has  come 
in  response  to  a  demand  for  more  accurate  psychological 
diagnosis — and  this  is  the.  first  function  of  the  psycholo- 
gical clinic  which  I  wish  to  discuss. 

1.  Expert  diagnosis  of  mentally  deviating  cases  and 
expert  prescription  and  consultation.  The  central  aim  of 
the  psychological  clinic  is  psychological  diagnosis  and  con- 
sultation and  advice  in  regard  to  mental  cases,  particularly 
children.  In  other  words,  the  aim  of  the  clinic  is  essen- 
tially practical.  The  clinical  psychologist  is  engaged  in 
serious  work  and  not  mere  play.  His  interests  are  not 
confined  to  the  theoretical  or  academic.  His  efforts  are  in 
the  field  of  human  conservation,  individual  orthogenesis 
and  remedial  philanthropy.  All  the  psychological  clinics, 
so  far  as  I  know,  are  doing  philanthropic  work.  The 
psycho-clinicist  is  concerned  with  the  proper  mental 
hygiene,  the  correct  educational  classification  and  the 
skilled  pedagogical  training  of  the  mentally  exceptional 
child. ^  The  aim,  in  one  word,  of  his  basic  effort  is  ortho- 
genesis (particularly  that  phase  of  orthogenesis  to  which 
I  have  applied  the  term  'orthophrenics'). 

It  is  rapidly  becoming  generally  recognized  that  the 
nature  and  extent  of  mental  variations  or  abnormalities 
cannot  be  adequately  ascertained  by  the  method  of  mere 
observation  or  inspection,  or  by  the  ill-adapted  methods  of 
specialists  in  the  fields  of  medicine.  Many  mental  devia- 
tions are  so  subtle  that  they  entirely  escape  common  obser- 

2  It  would  seem  better  to  call  the  psychological  clinics  in  the 
schools  psycho-educational  clinics,  just  because  of  the  fact  that  the 
character  of  the  diagnosis  attempted  is  distinctly  both  psychological 
and  educational,  and  because  the  aims  of  the  diagnosis  are  dis- 
tinctly the  scientific  pedagogical  training,  correct  educational  classi- 
fication and  mental  hygiene  of  the  educationally  exceptional  child. 


THE  PSYCHOLOGICAL  CLINIC  139 

vation.  Common  observation,  moreover,  rarely  penetrates 
so  far  as  to  reveal  the  cause  of  the  defect.  Before  the 
advent  of  experimental  and  clinical  psychology,  mental 
diagnosis  was  based  almost  wholly  upon  common  observa- 
tion, if  we  except  the  pedagogical  tests  of  the  schools  and 
a  few  tests  of  the  trained  psychopathologists.  Many 
mental  variations  or  abnormahties,  however,  are  harder  to 
get  at  by  mere  observation  than  many  physical  disorders. 
Many  of  the  latter  can  be  detected  by  the  methods  of  so- 
called  inspection,  auscultation,  palpation,  percussion  or 
mensuration.  Nevertheless,  the  skilled  physician  does  not 
depend  solely  upon  these  methods  of  diagnosis,  but  has 
developed  a  more  refined  laboratory  technique,  consisting 
of  radiographic  and  microscopic  inspection,  serum  reac- 
tion tests,  mechanical  and  electrical  tests  of  nervous 
sensitivity  and  response,  etc.  Likewise  the  psychologist 
within  the  last  decade  or  two  has  developed  a  new  science, 
which  is  now  usually  called  'clinical  psychology,'  and  a 
delicate,  controlled  laboratory  technique.  This  technique 
sometimes  involves  the  use  of  the  most  delicate  apparatus 
for  precisely  measuring  the  functional  capacity  of  the 
various  sensory,  motor  and  intellectual  processes.  At  other 
times  it  involves  the  use  of  less  elaborate  testing  appliances. 
For  purposes  of  practical  mental  diagnosis  the  tendency 
at  the  present  time  is  to  make  a  more  extensive  use  of  the 
simpler  forms  of  testing  devices,  such  as  test  blanks,  form 
and  construction  boards,  set  questions  and  graded  scales 
of  intellectual,  motor  and  socio-industrial  capacity.  The 
most  popular  of  the  developmental  scales  is  the  Binet- 
Simon  scale  of  intelligence,  which  consists  of  a  series  of 
tests  (sixty-two  in  the  1908  series  if  ages  one  and  two  are 
included)  gradually  increasing  in  difficulty  and  arranged 
in  age-steps.     There  are  from  three  to  eight  tests  in  each 


140    MENTAL  HEALTH  OF  SCHOOL  CHILD 

of  the  first  thirteen  years  of  life  in  the  1908  series.  Many 
of  these  tests  are  extremely  simple.  To  illustrate :  a  child 
who  can  follow  visually  a  hghted  match  moved  in  front  of 
his  face,  who  can  grasp  and  handle  a  block  placed  in  his 
hand  and  who  can  grasp  a  suspended  cylinder  is  credited 
with  a  mentality  of  one  year.  A  child  who  can  state  his 
sex,  who  can  recognize  and  name  common  objects,  such  as 
a  knife,  penny  and  key,  who  can  repeat  three  numerals 
heard  once,  and  who  can  designate  the  longer  or  shorter 
of  two  hues  differing  by  one  centimeter,  is  rated  as  four 
years'  old  mentally.  The  scale  is  constructed  merely  to 
test  the  stage  of  the  intelligence,  and  not  emotional  or 
motor  development.  The  stimulus  to  the  development  of 
this  scale  was  the  enactment  in  Paris  in  1904  of  an  edu- 
cational measure  which  required  the  individual  examination 
of  all  mentally  defective  children.  At  first  this  work  was 
left  to  the  medical  inspectors,  but  it  soon  became  evident 
that  they  could  do  no  more  than  they  already  had  done  in 
the  way  of  medical  inspection — namely,  detect  physical 
defects  and  diseases.  It  became  evident  that  there  was  no 
scientific  method  of  examining  mentally  exceptional  chil- 
dren in  existence,  and  hence  Binet  and  his  assistant,  Simon, 
set  about  to  establish  normal  mental  age-norms  by  examin- 
ing certain  pedagogically  average  children  in  the  elemen- 
tary schools  of  Paris  (children  of  the  working  classes  from 
the  poorer  sections).  They  arranged  certain  tests  in 
age-steps,  and  it  is  this  arrangement  of  the  tests  into  age- 
norms  that  has  made  the  tests  so  popular.  This  scale  is 
of  considerable  value  for  grading  intelligence,  but  it  has 
recently  been  subjected,  particularly  in  this  country,  to 
indiscriminate  exploitation  and  popularization,  so  that 
many  erroneous  ideas  have  arisen  in  respect  to  its  real 
function  or  the  real  function  of  psychological  examinations 


THE  PSYCHOLOGICAL  CLINIC  141 

in  general.  Almost  everything  that  has  been  written  about 
the  Binet  scale  (until  very  recently)  has  been  in  the  nature 
of  praise — both  judicious  and  extravagant,  rather  more 
of  the  latter.  I  think  it  is  worth  while,  therefore,  to  call 
attention  to  some  of  the  current  misconceptions  and  to 
sound  a  few  warning  notes,  regarding  psychological 
examinations. 

1.  Very  many  persons  who  are  not  trained  mental 
examiners  seem  to  think  that  the  Binet  testing  is  all  there 
is  to  a  mental  examination ;  that  it  is  the  only  serviceable 
method  we  have;  that  it  is  the  Alpha  and  Omega  of  psy- 
cho-clinical work.  Indeed,  that  is  about  all  there  is  to  the 
mental  examinations  conducted  by  amateurs.  This  is  a 
preposterous  notion.  It  is  quite  possible  to  give  from  one 
hundred  to  five  hundred  other  valuable  psychological  tests 
in  the  examination  of  a  case.  Of  any  one  single  scheme  of 
testing,  the  Binet  scale  is  probably  at  present  our  most 
valuable  instrument,  but  it  is  only  one  among  many  diag- 
nostic devices  at  the  command  of  the  trained  psychological 
examiner. 

2.  Another  fact  that  needs  to  be  emphasized  again  and 
again  is  that  simply  putting  a  child  through  the  Binet 
scale  does  not  tell  one  very  much  about  his  real  mental  idio- 
syncrasies, the  peculiarities  of  his  mental  constellations, 
his  particular  shorts  or  longs.  It  does  not  give  us  a  differ- 
ential diagnosis  of  type  or  of  cause  or  a  prognosis  of 
outcome,  except  in  certain  very  obvious  cases.  What  the 
Binet  scale  does  is  to  give  one  a  preliminary,  rough  or 
approximate  rating  of  the  child's  mental  level.  If  the 
child  is  in  the  schools  and  has  been  carefully  classified,  we 
already  have,  through  the  pedagogical  tests  and  grading, 
an  approximation  of  his  mental  standing — often  inaccu- 
rate, to  be  sure,  just  as  the  Binet  rating  sometimes  is. 


142    MENTAL  HEALTH  OF  SCHOOL  CHILD 

All  that  can  be  expected  from  the  Binet  testing  by  persons 
who  are  not  expert  psychological  examiners  is  usually 
merely  an  independent  confirmation  of  the  pedagogical 
rating  already  assigned  the  child  in  the  schools.  This  may 
be  of  value.  Sometimes,  however,  the  Binet  rating  will  be 
at  variance  with  the  teacher's  rating,  and  I  have  known  of 
cases  in  which  teachers  maintain  that,  because  they  have 
been  coming  into  contact  with  the  child  and  have  been 
studying  its  mentality,  day  by  day  for  months  or  years, 
their  judgment  in  regard  to  the  child's  mental  standing  is 
more  reliable  than  the  judgment  of  a  teacher,  nurse  or 
physician  who  has  spent  only  a  few  minutes  with  the  child 
in  putting  him  through  the  Binet  tests. 

It  is  doubtful  whether  the  Binet  tests  will  afford  to  an 
amateur  in  clinical  psychology  deeper  insight  into  the 
operation  of  the  child's  mind  than  the  pedagogical  tests 
afford  to  the  observant  teacher.  Certainly  the  Binet 
testing  of  itself  will  not  confer  any  remarkable  insight  or 
comprehension  upon  any  person  using  the  scale.  If  he 
already  has  accurate  knowledge  and  deep  insight  into 
mental  mechanisms,  the  Binet  testing  will  better  enable  him 
to  use  his  skill,  but  without  prior  erudition  or  technical 
skill,  the  Binet  testing  is  not  a  magical  something  that  will 
transform  a  person  into  a  mental  wizard  and  give  him 
occult  powers  to  penetrate  into  a  child's  mental  pecuHari- 
ties  and  reveal  the  treatment  he  requires.  The  Binet 
testing  is  not  a  device  for  supplying  brains  or  a  substitute 
for  a  technical  university  course.  It  is  just  as  preposter- 
ous to  think  that  one  can  become  a  skilled  mental  examiner 
merely  by  reading  books  on  mental  tests,  as  to  think  that 
one  can  become  a  skilled  surgeon  by  simply  reading  books 
on  surgery.  A  clinical  psychologist  uses  certain  formal 
tests  merely  as  the  physician  feels  the  pulse  or  takes  the 


THE  PSYCHOLOGICAL  CLINIC  143 

temperature.  A  physician  must  know  a  good  deal  more 
than  how  to  take  the  pulse  or  temperature  in  order  to 
physically  diagnose  his  cases.  Because  of  the  large  num- 
ber of  mental  defectives  in  the  schools,  we  shall  always 
need  a  number  of  assistants  to  give  certain  psychological 
tests,  but  their  function  is  that  of  the  nurse  in  relation  to 
the  physician  (see  Chapters  IX  and  X). 

3.  In  the  third  place,  the  notion  has  gotten  abroad 
that  the  Binet  scale  is  'infallible'  or  'amazingly  accurate.' 
I  have  attempted  to  show  that  both  of  these  statements  are 
false,  by  minutely  analyzing  the  results  of  the  daily  appli- 
cation of  the  scale  for  eight  months  to  epileptics.  Since 
these  results  have  either  been  ignored^  or  criticised  because 
they  have  been  based  upon  the  testing  of  epileptics,  I  have 
used  precisely  the  same  method  in  giving  the  tests  to  public 
school  clinic  cases.  Here  there  is  space  to  give  in  briefest 
form  the  results  merely  of  a  threefold  method  of  testing 
the  scale  with  the  public  school  cases  which  have  been 
examined  in  the  psycho-educational  chnic  of  the  School 
of  Education,  University  of  Pittsburgh.  (For  criticisms 
of  the  tests  growing  out  of  their  use  with  epileptics,  see 
Chapters  VI,  VII  and  VIII.) 

First,  I  have  compared  the  Binet  rating  or  classification 
with  the  pedagogical  classification  of  the  consecutive  cases 
which  were  thoroughly  examined.  Age  six  to  seven  was 
considered  as  the  normal  age  for  Grade  I.  Briefly,  the 
Binet  rating  gave  80.5  per  cent  as  retarded,  2.7  per  cent 
as  exactly  at  age  and  15.7  per  cent  as  accelerated  (based 
on  184  cases),  while  the  pedagogical  rating  gave  89.4 

3  One  of  my  recent  critics  ascribes  the  inaccuracy  of  the  Binet 
work  to  the  testers  and  not  to  the  scale.  My  investigations,  which 
have  revealed  the  inaccuracy  of  the  scale,  have  not  yet  been  experi- 
mentally refuted;  they  cannot  be  refuted  by  bare  denial. 


144    MENTAL  HEALTH  OF  SCHOOL  CHILD 

per  cent  as  retarded,  8.5  per  cent  as  on  time,  and  only  2 
per  cent  as  accelerated. 

Second,  I  have  determined  in  units  of  years  the  gross 
amount  of  mental  and  pedagogical  retardation  and  accel- 
eration of  all  those  children  tested  whose  school  records 
were  such  as  to  make  it  possible  to  determine  the  degree  of 
pedagogical  deviation  (134  cases).  The  mental  variations 
were  recorded  in  years  and  fractional  parts  of  years  by 
the  point  system  used  in  the  Binet  scale;  and  the  peda- 
gogical deviations  were  determined  more  or  less  according 
to  the  age-grade  method.  The  difference  between  the 
point  in  the  course  where  the  child  was  at  the  time  of  the 
examination  and  where  he  should  have  been  according  to 
his  age  was  determined  in  years  and  fractions  of  years. 
Graph  I  shows  that  the  gross  amount  of  Binet  retardation 
amounted  to  343.3  years  as  against  359.3  years  of  peda- 
gogical retardation;  and  the  corresponding  figures  for 
acceleration  were  24.4  years  as  against  6  years.  By 
both  of  the  above  methods  the  retardation  is  seen  to  be  less 
by  the  Binet  than  the  pedagogical  rating,  while  the  amount 
of  acceleration  is  decidedly  more  by  the  Binet  than  by  the 
pedagogical  rating. 

These  methods  of  comparison,  however,  are  subject  to 
criticism,  and  I  shall,  therefore,  pass  on  to  the  third  and 
more  important  method.  According  to  this,  all  the  con- 
secutive cases  which  had  been  thoroughly  examined  (184 
cases)  were  first  classified  strictly  according  to  the  Binet 
system,  with  the  exception  that  only  those  who  were 
retarded  more  than  three  years  were  classified  as  feeble- 
minded, while  children  less  than  nine  years  chronologically, 
who  were  retarded  two  years  or  over  or  less  than  three 
years  were  not  so  classified.  It  is  thus  apparent  that  I 
have  classified  less  cases  by  the  Binet  tests  as  feeble-minded 


TOT/IL /JMOUhT  OF  BINET- 

siMon  mo  PEDmoGic/iL  ymifl- 

^lON  SHOWN  BY  /54  PITTSBURGH 
SCHOOL  C/JSES. 


Retardation. 


345.3  urs. 


/Jcce/eratfon, 


559.5  ijrs. 


GRAPH  I. 


B'S, 


1 

Peda^ 
^ogical. 


24.4  yrs. 

I 

B-S. 


S.yrs, 

Peda- 
gogical. 


CL/Jss/nc/iTiON  or 
consECUT/vE  cunic  c/jses, 

Psijchal.  Clinic ,  Univ.  of  Pitt. 
Based  on  tlie  Binet  Testing  (1908  scale), 


/9.5H 


GRAPH  II. 


/«^% 


IU% 


7.0% 


4.8% 


1.0% 
I 

00 
CO 

N 


3.2% 


1. 


CM 


to 
o 

OsJ 


OsJ 

Pi 


CsJ 


Feeble-Minded^ 
2  7.  7% 


Retarded  QO.5% 


17.3% 


CM 
O 


Osi        CM 


9.2 'A 


2.7%' 


O 


CM 


3.8fo 


CM 

o 

CM 


2.7 


CO 

CM 
CM 


Accelerated 
J5,7% 


Normal 
29.2% 


CUSSIFIC/1TI0M  OF 
COhSECUT/VE   CLimC    C/ISES. 
PsLjchoi  Clink,  Univ.  of  Pitt. 

Based  on  all  the  pivailable  Facts. 

39:2% 


.5% 
I 


o 


GRAPH  III, 


f/.6% 


esTSi 


'e.6% 


o 


O 


/./% 


o 


Feeble -Minded  1 7.0% 


Subnormal   77.3% 


n.0%  1 1.  OX 


9.955 


to 

1 

■b 

f 

1 

5r> 

15 

CD 

1 

cS 

oc 

& 

eg 

.f 

148    MENTAL  HEALTH  OF  SCHOOL  CHILD 

than  the  Binet  system  permits.  In  the  second  place,  I  have 
gathered  all  available  data  on  the  cases  by  other  psycho- 
logical tests  and  by  other  inquiries,  and  have  based  my  own 
diagnoses  on  a  careful  study  of  all  the  facts  thus 
secured.  A  comparison  of  graphs  II  and  III  shows  that 
there  is  a  certain  degree  of  correspondence  between  the 
two  classifications.  The  Binet  rating  gives  4.7  per  cent 
more  supernormals  and  2.6  per  cent  more  subnormals. 
The  most  important  difference,  however,  is  in  the  number 
of  feeble-minded  and  backward  cases.  The  Binet  rating 
gives  10  per  cent  more  feeble-minded  and  from  15  to  20 
per  cent  less  backward  cases  than  the  final  estimate. 
If  we  also  consider  the  pupils  who  were  retarded  three 
years  (or  two  years  if  under  nine  years  of  age)  as  feeble- 
minded, the  discrepancy  would  be  perceptibly  increased. 
It  is  entirely  clear  to  my  mind  that  27  per  cent  of  these 
children  (as  shown  by  the  Binet  tests  on  the  above  basis) 
were  not  feeble-minded.  I  am  entirely  clear  on  the  propo- 
sition that  the  Binet  rating  in  the  hands  of  mere  Binet 
testers  will  give  us  entirely  too  many  feeble-minded  cases. 
This  conclusion  seems  to  be  abundantly  confirmed  by  recent 
reports  from  Binet  testers  in  the  public  schools.  To  cite 
only  two  instances :  In  one  city  49.7  per  cent  of  600  re- 
tarded children  (unselected  retardates  so  far  as  I  can 
gather)  and  in  another  80  per  cent  of  about  300  admis- 
sions to  special  classes,  were  classified  as  feeble-minded. 
In  the  latter  city,  the  astonishing  statement  is  made  that 
this  number  includes  only  15  per  cent  of  the  subnormals 
in  the  school  system  who  should  be  in  special  classes.  What 
a  terrible  focus  of  feeble-minded  degeneracy  this  city  must 
be !  Apply  this  same  ratio  of  feeble-mindedness  to  the 
6,000,000  retarded  children  in  the  schools  of  the  country, 
and   we   get   a   feeble-minded   school   population   of   from 


THE  PSYCHOLOGICAL  CLINIC  149 

3,000,000  to  4,800,000.  Of  course,  this  is  ludicrously 
absurd.  Even  if  the  cases  examined  were  rather  extreme, 
the  figures  are  still  entirely  extravagant.  Very  probably 
not  more  than  from  one-fourth  to  one-half  of  these  retard- 
ates were  feeble-minded.  I  will  venture  the  assertion  after 
years  of  teaching  in  the  public  schools  and  clinically  exam- 
ining public  school  cases,  that  the  oft-repeated  statement, 
that  '2  per  cent  of  the  general  school  population  is  defect- 
ive' (if  by  this  is  meant  feeble-minded),  exaggerates  the 
real  situation.  The  actual  number  is  probably  about  1  per 
cent.  Incidentally  I  may  say  that  the  percentage  of 
feeble-minded  found  among  prostitutes  by  Binet  testers 
is  also  too  large. 

It  is  important  to  emphasize  that  so  far  as  concerns  the 
diagnosis  of  individual  cases  (rather  than  the  statistical 
classification  of  homogeneous  groups  of  cases),  no  system 
of  formal  intelligence  tests  yet  devised  can  be  used  as  an 
infallible  measuring  rod  of  intelligence.  It  is  quite  certain 
that  if  the  psychological  diagnosis  of  school  children  is  to 
be  intrusted  to  laymen,  whether  teachers,  nurses  or  special- 
ists other  than  psychological  experts,  some  very  inaccurate 
and  pernicious  diagnoses  will  be  made  of  individual  cases. 
In  my  own  laboratory  my  diagnoses  of  individual  cases  are 
often  quite  at  variance  with  the  Binet  findings.  I  have 
sometimes  diagnosed  cases  with  only  a  slight  degree  of 
intellectual  arrest  as  'feeble-minded'  because  that  is  the 
prognosis  (one  two-year  old  who  will  probably  remain  at 
two,  tested  normal),  while  I  have  sometimes  diagnosed 
others  with  a  very  considerable  degree  of  deficiency  as 
merely  'backward.' 

Thus,  to  cite  only  two  cases :  'A'  is  a  gentleman,  twenty- 
eight  years  of  age,  who  has  spent  five  years  in  university 
work.     He  has  been  diagnosed  as  a  'moron,'  as  a  'degener- 


150    MENTAL  HEALTH  OF  SCHOOL  CHD^D 

ate,'  as  'a  case  of  constitutional  inferiority,'  as  'a  case  with 
paranoid  trends,'  etc.  According  to  the  Binet  tests  he  was 
clearly  'feeble-minded,'  as  he  measured  only  11.4  years  in 
the  1908  series.  Anyone  knowing  no  more  about  the 
technique  of  psychological  examination  than  the  Binet- 
Simon  scale  would  at  once  have  classified  him  as  'feeble- 
minded,' but  he  did  not  impress  me  at  all  as  being  feeble- 
minded. His  appearance,  speech  and  conduct  suggested 
the  polished  and  cultured  gentleman.  Accordingly,  I  put 
him  through  approximately  thirty  sets  of  mental  tests 
(other  than  twenty-five  individual  Binet  tests)  and  thirty 
moral  tests.  These  tests  demonstrated  that  there  was  a 
considerable  difference  in  the  strength  of  his  different 
mental  traits.  Some  traits  were  on  the  twelve-year  plane, 
some  on  the  fifteen-year,  some  on  the  sixteen-year,  and 
some  on  the  adult  plane.  In  some  mental  tests  he  did 
as  well  as  college  men.  He  passed  correctly  practically 
all  of  the  moral  tests.  Here  is  a  case  showing  more  or  less 
deficiency  in  respect  to  various  mental  traits ;  but  the  man 
is  not  feeble-minded,  contrary  to  the  Binet  rating  (a 
sexual  complex  was  at  the  root  of  his  trouble). 

'B'  is  an  attractive  girl  of  considerable  culture,  age 
seventeen,  studying  Latin,  history,  algebra  and  English  in 
the  tenth  grade  of  a  private  school.  She  entered  school 
at  the  age  of  seven,  but  has  attended  rather  irregularly 
because  of  precarious  health.  Her  school  work  is  not  very 
satisfactory.  The  most  marked  mental  defect  noticed  by 
her  teacher  is  her  forgetfulness.  By  the  Binet  tests  she 
would  be  rated  as  'feeble-minded,'  since  she  graded  only 
11.4  years.  But  no  one  but  a  psychological  tyro  or  a 
mere  Binet  tester  would  so  classify  her.  (Her  condition 
borders  on  psychasthenia.) 

While  intelligence  defect  is  the  most  obvious  trait  of 


THE  PSYCHOLOGICAL  CLINIC  151 

feeble-mindedness,  there  are  other  cHnical  and  develop- 
mental phases  which  must  be  taken  into  consideration 
before  a  positive  diagnosis  can  be  pronounced  in  many 
cases.  It  is  a  hazardous  and  unscientific  procedure  to  per- 
mit amateurs  to  brand  children  as  'feeble-minded'  solely 
because  they  show  a  considerable  degree  of  intelligence  re- 
tardation ;  it  is  a  serious  matter  always  to  classify  any  child 
as  'feeble-minded.'  Parents  ought  to  have  a  right  to  de- 
mand an  independent  examination  by  a  competent  psycho- 
educational  specialist  before  a  child  can  be  placed  in  a 
special  class.  In  London,  parents,  by  statutory  right,  may 
demand  an  examination  of  children  placed  in  special  classes 
every  six  months.  The  London  County  Council  has 
recently  appointed  an  expert  psychologist  to  mentally 
examine  school  children.  In  Paris,  a  special  examination 
for  mentally  defective  children  is  enjoined  by  law.  But 
this  examination,  at  least  the  final  diagnosis,  should  be 
made  by  a  specialist  whose  verdict  is  authoritative.  It  is 
certain  that  parents  will  be  far  more  ready  to  accept  a 
mental  diagnosis  if  it  is  made  by  a  competent  psychologi- 
cal expert.  In  some  cities  considerable  friction  has  arisen 
because  parents  and  teachers  have  not  always  been  willing 
to  accept  the  diagnosis  of  feeble-mindedness  made  by  teach- 
ers, nurses  or  physicians  who  are  amateurs  in  psychologi- 
cal work.  As  already  stated,  learning  how  to  give  a  few 
tests  is  no  substitute  for  a  prolonged  course  in  psycho- 
clinical  diagnosis.  Mere  tests,  whether  in  psychology  or 
medicine,  are  not  always  conclusive.  Even  positive  or 
negative  serum  reactions  sometimes  prove  nothing.  The 
psychologist,  just  like  the  physician,  must  base  his  diag- 
nosis on  both  laboratory  and  clinical  studies.  The  tests 
used  by  the  trained  psycho-clinicist  are  invaluable  in  that 
they  enable  him  to  arrive  at  a  more  accurate  clinical  pic- 


152    MENTAL  HEALTH  OF  SCHOOL  CHILD 

ture  of  the  mental  condition  of  his  case.  But  once  the  men- 
tal condition  has  been  determined,  there  remains  the  more 
difficult  task  of  locating  the  causes  of  the  trouble  and  pre- 
scribing a  differential  treatment  for  each  case.  The  accu- 
rate determination  of  the  causation  can  only  be  made  by 
investigating  the  personal  and  family  history  of  the  case ; 
the  hereditary  factors,  birth  condition,  record  of  diseases, 
physical  and  mental  development,  school  history,  mental 
habits,  social  heredity,  environments  and  present  physical 
and  mental  condition.  In  order  to  secure  all  the  desired 
data,  the  psycho-clinicist  should  be  able  to  command  the 
services  of  social  workers,  nurses,  medical  specialists, 
trained  helpers  to  assist  in  some  of  the  formal  testing  and 
record  and  filing  clerks.  Some  of  the  university  psycho- 
educational  clinics  have  a  physician  on  their  staff;  others 
have  a  staff  of  consulting  physicians  in  the  medical  school 
or  affiliated  hospitals  or  dispensaries. 

To  repeat:  the  first  function  of  the  psychological  clinic 
is  to  make  an  accurate  diagnosis  of  mentally  deviating 
children,  in  order  to  give  expert  advice  in  regard  to  the 
child's  mental  hygiene  (and  in  regard  to  the  physical 
treatment  in  so  far  as  this  is  orthophrenic  in  its  bearings) 
and  educational  care  and  training. 

11.  The  second  purpose  of  the  psychological  clinic  is  to 
serve  as  a  clearing  house  for  mentally  exceptional  cases. 
The  psychological  clinic  has  no  special  interest  in  cases 
which  are  not  mentally  or  pedagogically  exceptional  or 
abnormal.  Moreover,  its  interests  thus  far  have  been 
largely,  if  not  entirely,  restricted  to  juvenile  cases.  The 
psychiatric  clinic,  on  the  other  hand,  deals  more  largely 
with  adult  than  juvenile  cases;  and  technically  these  cases 
are  psychotic  or  incipiently  psychotic  in  character.  The 
psychological  (i.e.,  the  psycho-educational)  clinic  aims  to 


THE  PSYCHOLOGICAL  CLINIC  153 

serve  as  a  focal  point  where  the  data  bearing  on  mentally 
and  educationally  exceptional  children  may  be  brought 
together  for  careful  analysis  and  collation,  and  where 
the  cases  may  be  finally  disposed  of — some  to  institutions, 
some  to  special  classes,  some  to  hospitals  or  medical  clinics 
or  private  practitioners  and  some  to  special  courses  of 
corrective  pedagogics.  Some  psychological  cHnics  also 
conduct  medico-pedagogical  schools.  They  conduct  classes 
during  the  regular  or  summer  terms  and  offer  special  work 
in  corrective  pedagogics  (particularly  in  speech  training). 
Many  of  the  psychological  clinics  in  this  country  which 
are  properly  organized  have  become  clearing  houses  of 
this  character  for  juvenile  cases  in  the  schools  and  courts. 
Thus  in  Seattle  the  university  psycho-cHnicist  is  also  the 
consulting  psychologist  to  the  public  schools  and  the 
juvenile  court.  He  also  spends  part  of  his  time  examining 
cases  throughout  the  state.  In  Minneapolis  the  university 
psychologists  are  doing  work  both  for  the  public  schools 
and  for  the  juvenile  court.  Here  the  juvenile  court  has  a 
room  equipped  for  the  examination  work  in  the  court 
house.  In  New  Haven  the  Yale  clinical  psychologist,  who 
is  in  the  department  of  education,  but  who  has  his  labora- 
tory in  the  medical  school,  does  what  psycho-clinical  work 
there  is  done  in  the  city.  In  Baltimore  the  study  of  men- 
tally abnormal  children  is  undertaken  by  the  clinical  psy- 
chologist, who  is  (or  was  until  his  death)  connected  with 
the  Phipps  Psychiatric  Clinic.  The  University  of  Kansas 
examines  cases  at  Lawrence  and  elsewhere  in  the  state. 
The  clinic  in  the  State  University  of  Iowa  also  aims  to  do 
state-wide  work.  The  clinic  in  the  School  of  Education, 
University  of  Pittsburgh,  is  examining  cases  not  only  from 
Pittsburgh,  but  also  from  the  surrounding  towns  and 
country. 


154    MENTAL  HEALTH  OF  SCHOOL  CHILD 

HI.  The  third  function  of  the  psycho-clinicist  is  re- 
search, particularly  with  a  view  to  increasing  and  perfect- 
ing diagnostic  tests  and  to  extending  our  knowledge  of 
the  nature,  causes  and  treatment  of  mental  abnormalities. 
Owing  to  our  ignorance  in  this  field,  the  need  for  systematic 
research  is  paramount. 

IV.  A  fourth  function  of  the  psycho-clinic  comprises 
education  and  propaganda — the  dissemination  of  reliable 
information  and  knowledge  regarding  the  condition  and 
needs  of  the  mentally  abnormal  classes.  This  is  done 
through  the  offering  of  lecture  and  clinical  courses,  the 
publication  of  memoirs  and  investigations,  the  conducting 
of  demonstration  clinics,  etc.  There  is  constant  need,  e.g., 
to  develop  a  sympathetic  and  enlightened  public  opinion 
in  regard  to  the  needs  of  the  unreached  children  in  the 
public  schools,  in  order  that  they  may  be  properly  classified 
and  segregated,  so  that  they  may  receive  the  pedagogical 
training  which  befits  their  peculiarities.  There  is  need  for 
enlightened  pubhc  agitation  right  here  in  Pittsburgh,  to 
the  end  that  facilities  may  be  provided  for  the  large  army 
of  subnormal  school  children  in  our  public  schools.  Over 
10  per  cent  of  all  the  elementary  pupils  in  the  Pittsburgh 
public  schools  are  retarded  three  years  or  more.  It  is  safe 
to  say  that  one-half  of  this  10  per  cent  or  about  3,000 
pupils  should  be  in  'special'  classes  instead  of  in  the  regu- 
lar, 'ungraded,'  anemic  or  tubercular  classes.  And  yet 
Pittsburgh  today  does  not  have  a  single  special  class  in 
which  differentiated  training  is  provided  for  feeble-minded 
and  backward  children.  It  is  the  one  city  of  its  class  in 
the  United  States  without  special  classes  for  these  chil- 
dren.* In  March,  1911,  there  were  319  cities  in  the  country 

4  One  special  class  was  started  during  the  school  year  1913-1914. 


THE  PSYCHOLOGICAL  CLINIC  155 

which  had  estabhshed  classes  for  'mentally  defective'  and 
'backward'  children  (the  former  including  epileptic  classes 
and  the  latter  those  in  which  'special  teachers  are  employed 
to  assist  slow  pupils').  This  is  an  entirely  new  phase  of 
educational  work  in  Pittsburgh,  where  it  must  be  organized 
from  the  very  beginning.  (See  note  following  Chapter 
XIX.) 


CHAPTER  V 

THE    DISTINCTIVE     CONTRIBUTION    OF    THE 

PSYCHO-EDUCATIONAL  CLINIC  TO  THE 

SCHOOL  HYGIENE  MOVEMENT' 

It  is  only  in  the  twentieth  century  that  we  have  come 
to  recognize  that  the  conservation  of  school  children 
involves  more  than  inspection  for  physical  diseases  and 
defects,  more  than  medical  treatment  and  physical  hygiene, 
more  than  the  provision  of  school  lunches,  sanitary  drink- 
ing fountains,  schooUiouses  properly  regulated  in  regard 
to  temperature,  fresh  air  and  humidity,  open-air  classes 
for  the  tubercular  and  anemic  and  special  classes  for  the 
crippled,  deaf  and  bHnd.  It  is  only  within  the  last  few 
years  that  the  laity,  and  also  very  many  of  the  experts, 
have  so  much  as  suspected  that  there  is  a  realm  of  mental 
orthogenesis  (or  ortho phrenic s)  independent  of,  although 
supplementary  to,  the  realm  of  physical  orthogenesis  (to 
which  I  have  previously  applied  the  term  orthosomatics)  ; 
that  there  is  a  psycho-educational  type  of  school  inspec- 
tion entirely  different  from  physical,  medical  or  dental 
inspection ;  and  that  there  is  a  sphere  of  corrective  peda- 
gogics and  psycho-educational  therapeutics  paralleling 
the  sphere  of  dento-medical  care  and  the  surgical  removal 
or  correction  of  physical  handicaps. 

1  Delivered  before  the  session  on  Mental  Hygiene  and  the  Hygiene 
of  the  Mentally  Abnormal  Child,  at  the  Fourth  International  Con- 
gress on  School  Hygiene,  BufiFalo,  August  27,  1913. 


THE  PSYCHO-EDUCATIONAL  CLINIC      157 

How  loath  the  human  mind  is  to  recognize  or  sanction 
new  movements  may  be  best  indicated  by  the  fact  that 
while  this  International  Congress  has  a  section  devoted  to 
school  inspection  (or  health  supervision),  it  appears  from 
the  announcements  that  the  connotation  of  the  words 
'school  inspection'  is  confined  to  physical  inspection  (medi- 
cal and  dental),  although  numerous  theses^  have  been  pre- 
sented in  the  public  prints  during  a  number  of  years  to 
show  that  there  is  a  psycho-educational  type  of  inspection 
radically  different  from  dento-medical  inspection,  and 
although  this  type  of  inspection  is  now  an  accomplished 
fact  in  many  of  the  leading  centers  of  educational  endeavor 
throughout  the  country  (see  Chapters  II  and  XVIII).  It 
is  evident,  therefore,  that  we  must  extend  the  connotation 
of  the  term  'school  inspection'  so  that  it  will  include  three 
distinct  phases :  medical,  dental  and  psycho-educational. 

The  chnical  psycho-educationist  performs  certain  func- 
tions which  no  other  specialist  had  previously  been  trained 
to  perform.  The  pedagogue,  even  though  he  be  amply 
trained,  was  merely  prepared  to  instruct,  educate  and 
discipline  children,  but  had  no  qualifications  for  making 
anything  but  the  crudest  psychological  and  educational 
diagnoses.  He  was  in  no  sense  a  clinicist.  The  pediatri- 
cian knew  much  about  the  physical  diseases  of  young  chil- 
dren and  a  good  deal  about  the  diseases  of  older  children ; 
but  his  knowledge  of  children's   mental  and   educational 

2  Thus  articles  written  by  the  author  in  1909  (Medical  and  Psy- 
chological Inspection  of  School  Children,  The  American  School 
Master,  p.  435),  in  1911  (The  New  Clinical  Psychology  and  the 
Psycho-Clinicist,  Journal  of  Educational  Psychology,  p.  121,  191) 
and  in  1913  (Clinical  Psychology:  What  It  Is  and  What  It  Is  Not, 
Science,  p.  895;  The  Functions  of  the  Psychological  Clinic,  Medical 
Record,  September;  Re-averments  Respecting  Psycho-Clinical  Norms 
and  Scales  of  Development,  Psychological  Clinic,  p.  89). 


158    MENTAL  HEALTH  OF  SCHOOL  CHILD 

deviations  was  limited  to  the  merest  generalities,  and  his 
knowledge  of  the  examination  technique  of  the  psychologi- 
cal laboratory  and  of  educational  methodology  and  cor- 
rective pedagogy  was  extremely  meager  or  practically  nil. 
The  neurologists  and  psychopatJiolo gists  were  versed  in 
the  nervous  disorders  of  children  and  adults,  and  they 
knew  a  good  deal  about  the  phenomena  of  disordered  or 
alienated  mentality ;  but  they  knew  far  less  about  the  minor 
forms  of  mental  and  pedagogical  variation  which  more 
frequently  occur  in  exceptional  school  children,  and  they 
had  made  little,  if  any,  technical  study  of  educational, 
experimental  and  clinical  psychology,  of  child  study,  of 
the  principles  of  teaching  and  of  the  differential  pedagogic 
treatment  required  by  each  type  of  mentally  deviating 
child.  Likewise  the  ordinary  psychological  expert  knew  a 
good  deal  about  experimental  and  physiological  psychol- 
ogy and  more  or  less  about  educational  psychology  and 
child  study ;  but  usually  he  had  no  professional  training  in 
elementary  methods  or  special  pedagogics,  he  had  no 
training  in  clinical  technique  and  he  lacked  that  first-hand 
experience  with  cases  which  is  essential  in  order  to  become 
skilled  in  diagnosis. 

Here,  then,  was  a  field  of  diagnosis  for  which  the  exist- 
ing types  of  specialists,  whether  medical,  psychological  or 
educational,  had  practically  no  scientific  preparation 
whatever.  But  this  gap,  the  existence  of  which  is  now 
quite  obvious  to  the  intelligent  observer,  is  being  rapidly 
filled  by  the  development  of  psychological  or  psycho- 
educational  clinics.  To  America  belongs  the  chief  honor 
for  constructive  achievement  in  this  field  of  applied  psy- 
chology. In  America  we  are  rapidly  developing  a  new 
type  of  psychologist  or  educationist  trained  in  psycho- 
educational  diagnosis  and  orthogenesis. 


THE  PSYCHO-EDUCATIONAL  CLINIC      159 

With  the  rapid  multiplication  of  the  psychological 
clinics  during  the  last  few  years,  there  has  developed  a  feel- 
ing in  the  medical  profession  that  the  clinical  psychologist 
is  encroaching  upon  a  field  preempted  by,  and  held  sacred 
to,  the  physician.  This  fear,  however,  is  entirely  without 
foundation.  The  work  of  the  clinical  psychologist  {i.e., 
the  psycho-educational  clinicist)  and  the  medical  man  are 
not  competitive  or  duplicative,  but  supplementary  and 
correlative.  To  be  sure,  the  clinical  psychologist  (psycho- 
educational  clinicist)  wants  his  cases  medically  and  den- 
tally examined  in  order  that  he  may  more  accurately  inter- 
pret his  findings,  but  he  leaves  this  work  to  the  medical 
and  dental  specialists.  If  his  clinic  is  well  endowed,  he  will 
have  a  medical  specialist  or  a  number  of  medical  specialists 
on  his  staff;  otherwise  he  will  utilize  medical  consultants 
from  the  dispensaries,  hospitals  and  medical  schools.  The 
educational  clinicist  seeks  all  the  medical  data  available  on 
his  cases  precisely  as  he  seeks  all  the  sociological,  heredi- 
tary, pedagogical,  psychological  and  anthropometric  facts 
that  he  can  secure.  But  all  these  data  are  merely  contri- 
butory to  his  chief  purpose:  the  interpretation  of  the 
mental  and  educational  peculiarities,  abnormahties,  reduc- 
tions or  intensifications  revealed  by  his  psychological  and 
educational  tests  and  analyses.  And  the  purpose  of  an 
accurate  interpretation  of  the  psychological  and  educa- 
tional symptoms  is,  in  turn,  to  enable  him  to  prescribe 
appropriate  orthogenic  treatment.  This  may  consist 
in  giving  advice  to  the  parent  or  teacher  regarding 
the  proper  mental  hygiene  of  the  child  and  regarding  its 
proper  educational  classification  and  pedagogical  train- 
ing, or  it  may  consist  in  referring  the  case  to  the  dispen- 
sary, hospital  or  a  private  practitioner  for  medical,  dental 
or  surgical  care.     In  any  case,  the  function  of  the  psycho- 


160    MENTAL  HEALTH  OF  SCHOOL  CHILD 

educational  clinic  is  distinctly  ortJw phrenic;  namely,  the 
righting  or  correction  of  the  mental  functions  which  are 
deviating  or  abnormal,  either  by  the  removal  of  physical 
handicaps  or  by  proper  mental  and  educational  treatment ; 
the  stimulation  by  appropriate  stimuli  of  functions  which 
are  slowed  down  or  retarded,  and  the  placing  of  the  child 
in  the  right  educational  classification  or  environment,  so 
that  he  may  attain  with  the  least  expenditure  of  energy 
and  the  least  amount  of  friction  to  his  maximal  potential. 

The  clinic  strives  to  determine  what  are  the  inherent 
mental  and  educational  peculiarities  and  what  the  inherent 
strength  of  various  mental  functions  in  the  child;  whether 
he  is  only  apparently  or  genuinely  abnormal,  subnormal 
or  supernormal ;  in  which  mental  planes  he  is  deficient  and 
in  which  functions  he  is  talented.  But  always  the  purpose 
of  this  detailed  psycho-educational  analysis  is  to  furnish 
that  insight  which  will  enable  the  psychologist  to  place 
his  case  in  the  right  place  in  the  educational  system,  or  to 
so  adjust  the  educative  materials  and  methods  that  they 
will  minister  effectively  to  the  child's  peculiar  needs. 

From  what  I  have  said,  it  is  evident  that  the  interest  of 
the  psycho-educational  clinicist  is  in  children  who  are 
mentally  and  educationally  unusual  and  who  can  be  helped 
by  special  psychological  or  educational  treatment.  This 
group  includes,  among  other  types,  supernormal,  bright, 
backward,  feeble-minded,  epileptic,  psychasthenic,  neu- 
rotic, speech-defective  and  morally  and  emotionally 
unstable  children. 

At  the  University  of  Pittsburgh  we  are  conducting  a 
free  dispensary  psycho-educational  clinic,  to  which  the 
above  and  other  types  of  children,  including  child  prodi- 
gies, children  with  alexia,  agraphia  and  motor  defects  but 
without  corresponding  intellectual  impairment,  have  been 


THE  PSYCHO-EDUCATIONAL  CLINIC      161 

brought  by  parents,  teachers,  nurses,  physicians  and  social 
and  settlement  workers.  Of  a  limited  number  of  consecu- 
tive examinees  (the  first  184  who  were  thoroughly  exam- 
ined) which  I  have  tabulated,  11  per  cent  were  classified  as 
bright  or  supernormal,  11  per  cent  as  normal  and  77.9 
per  cent  as  subnormal.  Most  of  the  subnormals  were  back- 
ward ;  namely,  39.2  per  cent  of  the  entire  number  examined. 
Seventeen  per  cent  of  all  the  cases  were  classified  as  feeble- 
minded, 11.6  per  cent  as  border  cases  and  9.9  per  cent  as 
merely  retarded.  Eight  and  eight-tenths  per  cent  were 
classified  as  morons,  6.6  per  cent  as  imbeciles  and  .5  per 
cent  as  idiots.  While  very  few  of  the  feeble-minded 
belonged  to  any  special  type,  there  were  two  Mongolians, 
one  cretin,  one  paralytic  and  one  case  of  infantilism.  The 
average  amount  of  time  devoted  to  the  study  of  these  cases 
was  about  one  and  one-half  hours,  while  the  maximum  time 
given  to  any  one  case  was  over  twenty  hours.  This  case 
had  been  variously  and  fallaciously  diagnosed  as  a  moron, 
a  moral  imbecile,  a  degenerate  and  a  mild  paranoiac,  but 
the  mental  factors  which  were  found  to  be  responsible  for 
his  abnormal  behavior  pointed  to  an  entirely  different 
diagnosis. 

Some  of  the  advice  which  had  been  given  to  parents 
concerning  many  of  these  cases  would  be  termed  ludicrous, 
were  it  not  that  it  was  actually  tragic.  Parents  had  been 
told  by  so-called  experts,  'not  to  bother  about  their  child 
as  he  was  all  right ;  not  to  worry,  because  the  child  would 
outgrow  his  trouble  when  he  attained  the  age  of  six  or 
seven,  or  thirteen  or  fourteen.'  In  consequence  practically 
all  of  these  cases,  which  proved  to  be  utterly  hopeless  so 
far  as  concerns  restoration  to  normality,  had  been  educa- 
tionally neglected  for  years.  They  had  wasted  their  child- 
hood in  the  regular  grades  in  the  vain  endeavor  to  do  work 


162    MENTAL  HEALTH  OF  SCHOOL  CHILD 

for  which  they  were  utterly  unfitted.  Because  of  their 
inabihty  to  advance  they  had  either  been  neglected  in 
despair  by  the  teachers  or  they  had  unduly  monopolized 
the  teacher's  time  and  robbed  the  normal  pupils  of  the 
attention  which  by  right  was  theirs,  or  they  had  been  pro- 
moted irrespective  of  their  deserts  merely  to  relieve  the 
room  of  an  intolerable  burden.  The  crime  was  not  the 
pupil's  or  the  teacher's,  but  society's.  Society  still  com- 
placently tolerates  many  a  school  system  which  utterly 
lacks  the  requisite  machinery  for  the  scientific  psycho- 
educational  classification  of  its  educationally  exceptional 
children,  but  it  also  must  be  conceded  that  one  of  the 
stumbling-blocks  to  progess  in  work  with  mentally  abnor- 
mal children  is  the  schools  themselves.  During  the  past 
year  I  have  had  the  interesting  experience  of  having 
several  teachers  report  to  me  that  they  wanted  to  send 
cases  to  the  chnic  for  examination,  but  the  principals 
refused  permission.  The  principals  said:  'The  children 
are  all  right ;  we  will  leave  well  enough  alone,  and  proceed 
as  we  have  done  before.  The  fault  is  not  with  the  children 
but  with  the  inefficient  teachers.' 

And  now  an  interesting  point  is  this:  two  parents 
brought  me  two  cases  which  the  principal  had  refused  to 
send.  Both  of  these  children  proved  to  be  imbeciles.  And 
yet  the  omniscient  principal  had  said  that  they  were  all 
right  and  that  the  fault  was  the  teacher's.  As  a  general 
proposition  the  teachers  who  work  daily  with  the  pupils 
can  gauge  their  mentahty  more  accurately  than  many 
principals  or  superintendents. 

The  moral  of  my  story  is  simply  this :  just  as  the  schools 
now  pedagogically  examine  children  as  a  matter  of  course, 
of  legal  right  and  of  routine,  in  order  properly  to  grade 
and  promote  them,  so  must  the  schools  as  a  matter  of  legal 


THE  PSYCHO-EDUCATIONAL  CLINIC      163 

right  and  as  a  matter  of  fixed  routine,  psychologically 
examine  all  mentally  unusual  children,  so  that  they  may 
be  more  accurately  mentally  and  educationally  classified 
and  diagnosed.  Only  thus  can  we  economically  and  scien- 
tifically train  all  the  children  of  all  the  people.  Every 
large  school  system  should  employ  a  psycho-educational 
specialist  who  is  as  thoroughly  trained  in  this  work  as  the 
best  medical,  neurological  or  psychiatric  specialists  are 
trained  in  their  work. 

Discussion  following  the  reading  of  the  above  paper. 

In  answer  to  Dr.  Ira  S.  Wile's  remarks : 

Under  ideal  conditions  we  ought  to  subject  every  school 
child  to  a  psycho-educational  examination  at  the  time  that 
it  enters  school  for  the  first  time,  and  periodically  there- 
after in  case  it  does  not  develop  normally.  But  I  do  not 
advocate  this  in  practice,  because  to  carry  out  such  a 
program  of  work  would  require  larger  staffs  of  experts 
than  the  taxpayers  will  be  ready  to  support.  I  do  say, 
however,  that  every  child  who  is  retarded  not  more  than 
two  years  in  his  school  work,  and  every  child  who  is  obvi- 
ously or  even  apparently  mentally  peculiar  or  abnormal, 
should  be  given  a  special  psycho-educational  examination, 
in  addition  to  the  regular  dento-medical  examinations 
which  are  now  regularly  given  in  all  large  school  systems. 

The  methods  and  aims  of  a  psycho-educational  examina- 
tion are  not  the  same  as  those  of  a  medical  examination. 
The  psycho-educational  clinic,  while  closely  related  to,  is 
not  identical  with,  the  neurological  or  psychopathic  clinic. 
I  should  say  that  the  average  physician  would  require 
three  or  four  years  of  technical  training  in  order  to  be  able 
to   learn   skillfully  to   psychologically   and   educationally 


164    MENTAL  HEALTH  OF  SCHOOL  CHILD 

examine  a  mentally  unusual  child  and  skillfully  to  direct 
his  educational  development,  just  as  I  should  say  that  it 
would  require  a  similar  period  of  time  for  the  average 
psychologist  to  fully  qualify  himself  to  examine  children 
medically  (as  well  as  psychologically).  I  do  not  think 
we  shall  soon  reach  the  point  where  either  the  medical  men 
or  the  psychologists  (or  the  clinical  educationists)  will  be 
ready  to  spend  three  or  four  extra  years  of  prescribed 
study,  in  order  to  qualify  themselves  as  double  examiners 
(medical  and  educational).  Therefore,  I  maintain  that 
we  need,  as  a  minimum,  two  types  of  specialists  for  the 
work  of  examining  and  directing  the  care  and  training  of 
mentally  exceptional  children ;  an  educational  specialist 
thoroughly  trained  in  the  art  of  psycho-educational  diag- 
nosis and  in  the  differential,  corrective  pedagogics  apper- 
taining to  the  different  types  of  educationally  exceptional 
children ;  and  a  medical  man  who  has  had  special  prepara- 
tion in  the  art  of  detecting  physical  defects  and  in  pedi- 
atrics, neurology  and  psychiatry.  The  problems  concern- 
ing the  diagnosis,  care,  training  and  education  of  the  many 
types  of  mentally  and  educationally  exceptional  children 
are  so  varied  and  complex  that  one  type  of  specialist  very 
probably  cannot  develop  sufficient  skill  to  satisfactorily 
handle  them  all. 

In  answer  to  the  question :  What  do  you  do  for  your 
cases  after  you  have  examined  them.^ 

That  depends  entirely  on  the  results  of  the  examination. 
There  is  no  specific  of  universal  applicability.  There  are, 
indeed,  certain  cases  which  can  profitably  be  subjected  to 
the  same  educative  processes,  but  many  cases  require  dif- 
ferentiated educational  treatment.  In  the  case  of  a  peda- 
gogically  retarded  child  who  rates  normal  mentally  and 
whose  school   retardation  is   due  to   adventitious   factors 


THE  PSYCHO-EDUCATIONAL  CLINIC      165 

(frequent  transfer  from  school  to  school,  absence  because 
of  illness,  disinterest,  etc.),  I  should  not  prescribe  a  special 
curriculum  of  corrective  work,  but  more  individual  atten- 
tion. His  is  a  problem  for  the  'ungraded  teacher,'  and 
not  for  the  special  class  teacher.  On  the  other  hand, 
speech-defectives,  the  feeble-minded,  children  weak  in 
spelling  or  reading,  etc.,  require  special  courses  of  correc- 
tive exercises.  Moreover,  every  peculiar  case  should  be 
carefully  followed  and  subjected  to  later  examinations  so 
that  the  treatment  may  be  modified  to  meet  individual 
developmental  needs. 


CHAPTER  VI 

HUMAN  EFFICIENCY' 

A  Plan  foe  the  Observational,  Clinical  and  Experi- 
mental Study  of  the  Personal,  Social,  Indus- 
trial, School  and  Intellectual  Efficiencies  of 
Normal  and  Abnormal  Individuals 

The  questions  of  first  importance  in  the  study  of  mental 
defectives  are  the  questions  of  etiology,  medical  treatment, 
educational  training  and  guidance  and  criminal  responsi- 
bility. Etiology  naturally  claims  a  large  share  of  con- 
sideration, because  it  is  only  after  the  etiological  factors  or 
agents  of  different  abnormalities  have  been  precisely  deter- 
mined, that  we  are  in  a  position  to  prescribe  effective 
remedial  and  prophylactic  treatment,  or  to  deal  success- 
fully with  the  educational  problems  affecting  defectives. 

The  criminal  and  legal  aspects  likewise  deserve  a  large 
measure  of  attention.  Various  forms  of  mental  (and  pos- 
sibly anthropometric)  abnormality  predispose  toward 
criminality.  It  is  of  vital  social  importance  to  determine 
what  types  or  classes  of  defectives  lack  moral  insight  and 
appreciation  of  moral  values,  the  ability  to  distinguish 
between  right  and  wrong,  or  truth  and  error,  the  power  of 
self-control,  and  the  feelings  of  shame,  obligation  and 
guilt.  What  classes  of  defectives  are  incapable  of  living 
in  a  normal  human  environment.''     How  do  criminalistic 

1  Read,  in  part,  before  the  New  York  Branch  of  the  American 
Psychological  Association,  February  4,  1911. 

Reprinted  from  the  Pedagogical  Seminary,  1911,  pp.  74-84. 


HUMAN  EFFICIENCY  167 

tendencies  and  moral  discernment  vary  ^vith  degree  of 
defect,  type  of  disease  {e.g.,  delusional  insanities,  epileptic 
manias),  duration  of  disease,  transitory  states  (well  known 
are  the  occasional  or  transitory  states  of  moral  irresponsi- 
bility in  some  forms  of  epilepsy  and  in  delusional  and 
manic-depressive  forms  of  insanity,  which  show  themselves 
in  maniacal  outbursts,  and  kleptomaniac,  suicidal  and 
homicidal  tendencies)  and  environmental  conditions?  The 
obligation  of  the  state  properly  to  protect  the  lives  of  its 
subjects,  renders  the  study  of  questions  affecting  the  moral 
responsibihty  of  various  kinds  of  defectives  of  fundamental 
social  importance.  The  solution  of  the  practical  educa- 
tional, custodial  and  legal  problems  concerning  defectives 
will  hinge  largely  upon  the  answers  which  scientific  investi- 
gation gives  to  questions  of  this  nature. 

While  the  medical  and  legal  questions  are  thus  of  great 
importance,  it  is  also  important  to  secure  accurate  knowl- 
edge concerning  the  personal,  social,  industrial,  school  and 
intellectual  capacities  and  incapacities  of  various  grades 
and  classes  of  defectives,  such  as  idiots,  imbeciles,  morons, 
laggards,  epileptics  and  insane,  blind,  deaf,  mute  and 
crippled  persons.  There  are  thus  five  sides  to  the  question 
of  efficiency. 

First  of  all,  what  is  the  personal  efficiency  of  a  given 
grade  or  class  of  defectives.^  What  can  the  indi\'idual  do 
for  his  own  care  and  protection?  Can  he  feed  and  clothe 
himself,  avoid  dangers  and  temptations,  control  the  primal 
instincts  of  appetite,  sex,  love,  hate,  anger,  fear,  jealousy, 
pugnacity,  etc.?  Where  does  he  stand  in  the  personal 
efficiency  scale?  What  is  the  amount  of  his  personal  effi- 
ciency retardation,  as  measured  in  terms  of  the  personal 
capacities  of  a  normal  person  of  the  same  age?  The 
answers  to  these  questions  involve  the  establishment  of  age- 


168    MENTAL  HEALTH  OF  SCHOOL  CHILD 

norms  of  personal  efficiency — a  task  that  probably  cannot 
be  done  with  any  nicety  except  for  the  first  years  of  hfe. 

In  the  second  place,  what  is  the  nature  of  the  social 
capacities  or  incapacities  of  a  given  defective,  or  a  typical 
defective  of  a  given  class?  Is  the  individual  able  to  com- 
municate liis  ideas  or  desires  through  written  or  oral  lan- 
guage or  through  cries  or  gestures?  Can  he  converse 
coherently  or  intelligently?  Does  he  seek  or  avoid  social 
intercourse,  conversation,  entertainments,  games,  etc.?  Is 
he  socially-minded  or  anti-social?  Is  he  chummy,  enter- 
taining, generous,  sympathetic,  timid,  retiring,  fretful, 
suspicious,  deceitful,  quarrelsome,  slanderous,  brutal, 
murderous,  lascivious,  sexually  immoral,  subject  to  exhi- 
bitionism or  negativism,  lying,  thieving,  etc.  ?  Does  he  fit 
into  the  social  organism?  Can  he  so  adjust  himself  to  the 
customs  and  rules  of  society  that  he  will  not  become  a 
public  menace?  In  short,  what  is  the  character  of  the 
individual's  social  deviation?  What  is  his  social  efficiency 
age?  Is  he  on  the  level  of  the  morally  undiscerning  civi- 
lized young  child  or  in  the  stage  of  the  brutal  adult 
savage  ? 

In  the  third  place,  what  is  the  industrial  and  vocational, 
or  motor,  efficiency  of  various  defectives?  What  kinds  of 
work  can  they  do,  and  how  well?  How  much  can  they  do 
for  their  own  support?  Wliat  particular  capacities  are 
present  or  lacking?  What  special  existent  occupational 
interests  may  be  utilized?  What  is  the  individual's  atti- 
tude toward  work  and  toward  supervision  and  correction? 
What  are  his  learning  capacities?  What  working  habits 
can  he  form?  What  new  tasks  can  he  master?  To  what 
extent  are  his  industrial  capacities  improvable  by  training? 
What  is  his  best  line  of  work?  How  does  his  industrial 
efficiency  vary  from  time  to  time?     (Witness  the  striking 


HUMAN  EFFICIENCY  169 

variations  in  epileptics.)  What  is  the  productive  capacity 
of  a  given  defective  in  comparison  with  a  normal  person 
of  like  maturity,  and  to  what  extent  can  the  productive 
capacity  be  increased?  In  a  word,  what  is  the  amount  of 
the  motor  or  industrial  defect,  or  what  is  the  motor  and 
industrial  age,  of  a  given  defective?  These  questions 
demand  solution  before  the  pedagogy  of  the  industrial  and 
vocational  training  of  defectives  can  be  placed  upon  a 
satisfactory  basis,  and  before  the  labor  of  the  patients  in 
institutions  for  defectives  can  be  so  organized  as  to  afford 
maximal  returns. 

In  the  fourth  place,  what  is  the  nature  of  the  academic 
or  school  capacities  of  different  grades  and  classes  of 
defectives?  What  sort  of  lessons  can  be  mastered?  In 
which  branches  do  they  make  progress?  Which  subjects 
are  worth  teaching?  What  methods  must  be  employed  to 
obtain  maximal  results?  How  does  the  rate  of  progress 
differ  from  the  normal  rate  (the  rate  with  normals)  ? 
What  is  the  precise  rate  and  character  of  the  improve- 
ment from  month  to  month  or  year  to  year,  as  measured 
by  scientifically  devised  serial  tests  of  equal  difficulty,  of 
those  mental  functions  which  are  central  in  the  learning 
process ;  namely,  perception,  attention,  association,  mem- 
ory, imagination,  linguistic  construction  and  reasoning? 
What  kinds  of  improvement  prove  to  be  pennanent,  what 
merely  transitory?  What  are  the  special  difficulties  of  a 
given  defective?  What  are  his  native  or  acquired  inter- 
ests, attitudes,  ability  to  observe,  judge,  reason,  form 
habits,  adapt  himself  to  changed  schedules  and  new  condi- 
tions, to  learn  by  instruction,  or  imitation,  or  hit-and- 
miss  experimentation,  or  repetition  (drill  processes),  or 
reasoning?  How  many  years  over-age  is  the  child  for  his 
grade?     That  is,  what  are  the  nature  and  extent  of  his 


170    MENTAL  HEALTH  OF  SCHOOL  CHILD 

pedagogical  retardation?  What  is  his  pedagogical  age? 
We  cannot  hope  to  adapt  our  curricula  to  the  varying 
needs  of  defective  children  until  we  have  thrown  the  search- 
light upon  these  vital  school  problems. 

Finally,  we  have  the  basal  question  of  the  character  of 
the  intellectual  disorganization  and  the  degree  of  the 
intellectual  arrest  of  various  defectives.  This  question  is 
fundamental,  because  all  the  other  capacities  depend  more 
upon  the  intellectual  integrity  of  the  individual  than  upon 
the  integrity  of  any  other  group  of  functions.  Here  we 
must  ascertain,  not  so  much  the  range  of  the  individual's 
information  or  his  erudition,  as  the  degree  and  character 
of  his  native  and  acquired  intellectual  grasp,  capacity  or 
ability.  Is  his  intellectual  development  normal,  or  has  it 
been  arrested  from  the  start,  or  has  it  become  atrophied 
with  time.?  What  particular  intellectual  functions  have 
suffered  the  greatest  impairment?  Where  along  the  intel- 
lectual highway  from  the  low-grade  idiot  up  through  the 
imbecile,  moron  and  laggard  to  the  normal  person,  has  the 
individual  stopped  .'^  What,  in  a  word,  is  the  individual's 
intellectual  age?  Can  this  be  determined  in  definite  units, 
or  by  diagnostic  age  tests,  more  precisely  than  can  be 
done  by  observation  or  by  the  use  of  school  grades .'' 

The  above  are  fundamental  questions  which  must  be 
properly  answered  before  we  can  presume  to  deal  intelli- 
gently with  the  problems  affecting  the  housing,  segrega- 
tion, care,  treatment  and  education  of  public  school  and 
institutional  types  of  defectives,  or  before  we  can  deal 
intelligently  with  normal  and  supernormal  children. 

At  the  New  Jersey  State  Village  for  Epileptics"  it  was 

2  A  laboratory  of  clinical  psychology  was  established  by  the  Board 
of  Managers  at  this  institution  in  October,  1910,  under  the  director- 
ship of  the  writer. 


HUMAN  EFFICIENCY  171 

my  privilege  recently  to  inaugurate  investigations  of  the 
above  questions  by  observational,  clinical  and  experimental 
methods,  and  to  prepare  a  series  of  record  blanks  on  wliich 
to  record  the  data.  These  forms  are  uniform  in  size 
with  the  other  forms  in  use  in  the  institution  and  are  so 
made  that  they  can  be  gathered  into  book  form  and  thus 
provide  a  case  history  for  each  patient. 

In  order  to  determine  the  patient's  intellectual  status  we 
have  been  giving  the  form-hoard  test,  which  throws  light 
upon  the  patient's  ability  to  visually  identify  forms,  upon 
his  constructive  capacity  and  his  power  of  muscular  co- 
ordination; the  hand  dynamometry  test,  which  roughly 
tests  the  power  of  voluntary  attention  and  effort,  and  par- 
ticularly the  power  of  muscular  exertion ;  the  Binet-Siinon 
tests  of  intellectual  development  (all  of  the  above  are  on 
Form  I)  ;  and  a  set  of  six  serial  or  consecutive  controlled 
group  tests  (Form  V^).  The  latter  tests  were  given 
serially  (one  set  each  month)  to  somewhat  over  thirty  of 
our  brightest  epileptic  school  children,  and  to  somewhat 
less  than  100  dull,  average  and  bright  pupils  from  the 
second  to  the  third  high-school  grades  in  a  nearby  public 
school.  Owing  to  our  late  start,  and  the  writer's  removal 
from  the  institution,  these  tests  could  be  given  only  during 
five  months ;  it  would  have  been  better  to  have  given  them 
once  every  second  month  during  the  course  of  the  entire 
year.  These  group  measurements  embrace  tests  of  various 
mental  processes  fundamental  to  intellectual  operations : 
accuracy  of  perception,  perceptual  discrimination,  obser- 

3  Four  of  the  forms  were  distributed  at  the  meeting.  Form  I  also 
contains  a  number  of  miscellaneous  tests;  Form  II  deals  with  the 
'effect  of  con\Tilsions  on  mental  traits  and  capacities';  Form  III  is  a 
'personal,  social  and  industrial  efficiency  report';  Form  IV  is  a  'school 
efBciency  report';  and  on  Form  V  is  recorded  'serial  experimental 
tests  of  the  growth  and  improvement  of  mental  traits  and  capacities.' 


172    MENTAL  HEALTH  OF  SCHOOL  CHILD 

vation  and  reaction;  the  capacity  to  memorize  and  the 
power  of  immediate  and  prolonged  retention;  the  rate  of 
forming  spontaneous  associations  with  determinate  ante- 
cedents, the  abiHty  to  form  such  controlled  associations  as 
are  involved  in  adding  columns  of  ten  one-place  digits  and 
supplying  antonyms  to  a  set  of  simple  words  ;  the  ability  to 
retain  a  list  of  logical  and  illogical  sequents  with  determi- 
nate antecedents  from  one  reading  by  the  experimenter, 
during  a  period  of  a  couple  of  minutes  and  during  a 
period  of  four  weeks ;  the  capacity  for  visual  imagination ; 
and  the  capacity  for  linguistic  construction  as  evidenced 
by  the  ability  to  construct  a  maximal  number  of  sentences 
each  of  which  must  contain  three  supphed  nouns  or  verbs. 
The  aim  has  been  to  make  each  of  the  six  successive  tests 
in  the  same  series  different  but  at  the  same  time  equally 
difficult,  and  all  so  difficult  that  no  one  can  make  a  perfect 
score,  so  that  they  may  serve  as  an  experimental  measuring 
scale  of  the  growth  and  improvement  which  various  mental 
capacities  or  traits  undergo  from  month  to  month  or  year 
to  year  as  a  result  of  normal  maturation,  education,  train- 
ing, familiarity,  removal  of  physical  defects,  proper  regu- 
lation of  temperature  and  humidity,  or  abstention  from 
tobacco  or  alcohol.  By  giving  these  tests  to  many  normal 
children  from  season  to  season  or  year  to  year  it  is  possible 
to  establish  normal  rate  norms  of  development  for  the 
traits  tested,  by  which  to  measure  individual  retardations 
or  accelerations,  as  well  as  the  differences  in  the  capacities 
of  various  classes  of  children  (normal,  bright,  dull,  back- 
ward, epileptic,  feeble-minded).  Several  of  these  tests  were 
originally  prepared  for  use  with  a  'dental  squad'  of  Cleve- 
land school  children  receiving  special  prophylactic  and 
operative  dental  treatment,  in  order  to  measure  in  definite 
units  the  effects  of  such  treatment  upon  mental  efficiency. 


HUMAN  EFFICIENCY  173 

The  use  of  these  tests  for  this  purpose  gave  very  gratify- 
ing results.  The  twelve  tests  which  I  have  worked  out — 
two  are  repeated  during  the  following  sitting  in  such  a 
way  as  to  transform  them  into  new  tests — may  not  afford 
the  best  measuring  scales,  but  they  furnish  an  initial  set 
which  can  be  altered  and  improved  as  experience  demands. 
The  materials  for  these  tests,  together  with  the  directions 
for  giving  them,  may  be  secured  from  the  C.  H.  Stoelting 
Co.,  Chicago,  111.  The  results  of  the  experiment  have 
been  tabulated,  but  have  not  yet  appeared  in  print. 

The  Binet-Simon  measuring  scale,  with  which  I  have 
made  a  survey  of  the  entire  \allage,  enables  us  to  make  a 
fairly  satisfactory  determination  of  the  degree  of  intel- 
lectual arrest  of  the  patients,  although  the  tests  are  faulty 
in  various  particulars  (see  Chapters  IV,  VIII,  IX,  X). 
Here  it  may  be  pointed  out  that  the  aggregate  difficulty  of 
the  tests  for  a  given  age  may  be  greater  than  that  for  a 
higher  age ;  some  tests  are  of  questionable  utility,  notably 
those  for  the  higher  ages ;  the  tests  need  to  be  extended  so 
as  to  include  more  of  the  teens,  and  this  is  more  difficult 
because  in  the  teens  one  year  makes  less  difference  in  intel- 
ligence than  one  year  during  the  early  years  of  childhood. 
Moreover,  it  is  not  yet  certain  whether  the  scale  is  appli- 
cable to  the  higher  grade  adult  dements  or  to  slightly 
retarded  adolescents  (it  seems  to  apply  fairly  well  to  most 
demented  idiots,  and  particularly  to  amented  idiots, 
imbeciles  and  low-grade  morons)  ;  nor  is  it  certain  that  the 
same  tests  are  applicable  to  both  boys  and  girls,  except 
during  the  preadolescent  period,  owing  to  the  difference  in 
the  physiological,  psychological  and  pedagogical  maturity 
of  boys  and  girls  of  the  same  chronological  age. 

After  some  tests  have  been  repeated  sufficiently  often 
in  a  given  school  or  locality  to  render  them  familiar,  it  is 


174    MENTAL  HEALTH  OF  SCHOOL  CHILD 

possible  for  the  higher  grade  examinees  to  compare  notes 
and  coach  one  another.  This  has  happened  in  my  experi- 
ence both  with  pubHc  school  and  high-grade  institutional 
cases.  This  will  enable  some  pupils  to  pass  the  tests 
beyond  their  intellectual  age,  and  will  transform  the  meas- 
uring scale  into  a  series  of  tests  of  the  ahility  to  learn  par- 
ticular facts  or  to  acquire  particular  accomplishments,  by 
dint  of  direct  instruction.  But  the  tests  are  not  designed  to 
try  the  momentary  capacity  to  acquire  a  determinate  set 
of  facts  by  special  instruction,  but  to  measure  the  capacity 
to  solve  certain  problems  without  special  preparation. 
They  are  intended  to  be  a  measuring  rod  of  the  intellectual 
capacity  or  strength  which  normal  children  of  various  ages 
and  of  a  given  type  of  civilization  should  have  developed 
as  a  result  of  normal  growth  and  development.  They  thus 
supply  a  series  of  age  norms  of  native  and  acquired  mental 
capacity ;  not  of  native  capacity  only,  as  has  been  assumed. 
It  would  be  fatuous  to  attempt  to  construct  a  scale  for  the 
measurement  of  pure  native  capacity,  for  pure  native 
capacity,  after  the  first  few  months  of  life,  is  a  pure  fig- 
ment of  the  imagination.  Only  by  excluding  the  psychical 
and  social  environmental  influences  would  there  be  any 
possibility  of  measuring  native  endowment  independent  of 
acquired  capacity.  A  measuring  scale  will,  therefore, 
measure  both  native  and  acquired  capacity.  Just  as  native 
capacity  differs  with  individuals,  so  will  the  capacity  to 
acquire  differ  with  individuals ;  but  there  is  probably  a 
certain  rate  of  acquisition  which  is  fairly  normal  in  a 
given  order  of  civilization,  so  that  it  will  be  possible  to 
establish  norms  which  hold  for  the  great  mass  of  average 
or  typical  individuals. 

Fortunately    the    difficulty    of    which    we    have    just 
spoken,  the  possibility   of  being  coached  so   as  to   pass 


HUMAN  EFFICIENCY  175 

some  tests,  can  be  met  by  devising  substitute  or  variant 
forms  of  equal  difficulty  for  some  of  the  tests. 

The  basis  of  initial  rating  and  the  corrective  formula  or 
the  method  of  giving  advance  credits  (one  year  for  every 
five  points  passed  in  higher  ages)  sometimes  create  diffi- 
culties. This  is  due  to  the  fact  that  the  number  of  tests  in 
the  various  ages  in  the  1908  scale  is  not  uniform,  and  to 
the  fact  that  subjects  may  pass  superior  ages  while  failing 
on  lower  ones.  In  four  ages  in  the  1908  scale  the  number 
of  tests  is  four  (ages  four,  five,  ten  and  twelve)  ;  in  two  it  is 
five  (three  and  eleven)  ;  in  two  six  (eight  and  nine)  ;  in  one 
seven  (age  six)  ;  and  in  one  eight  (age  seven).  The  con- 
sequence is  that  the  subject  sometimes  receives  too  few  and 
sometimes  too  many  credits.  To  illustrate  cases  from  my 
experience:  if  the  subject  passes  age  six  by  virtue  of  two 
failures  in  age  seven,  he  can  obtain  one  and  one-fifth  year 
of  credit  for  age  seven ;  i.e.,  one-fifth  of  a  year  more  credit 
than  if  he  were  credited  outright  as  having  passed  age 
seven.  If  he  fails  on  age  six  but  passes  age  ten  he  can  still 
be  rated  as  ten  years  mentally.  The  maximum  discrep- 
ancies which  I  have  found  arising  from  different  bases  of 
rating  have  amounted  to  over  three  years,  while  for  39 
per  cent  of  103  epileptic  cases  studied  they  amounted  to 
one  year  or  over.  This  difficulty,  however,  is  not  innate  in 
the  tests  themselves,  and  can  be  overcome  by  equalizing 
the  number  of  tests  in  each  age,  as  has  been  done  in  the 
1911  revision,  by  rearranging  the  tests,  or  revising  the 
corrective  formula  as  may  be  needed. 

There  are  two  methods  by  which  to  scientifically  ehmi- 
nate,  revise,  add  or  amplify  tests  in  the  Binet  scale.  First, 
by  testing  masses  of  physically  and  mentally  normal  public 
school  children.  But  it  is  necessary  to  emphasize  that  the 
testing  must  be  a  thoroughgoing  try-out.    To  examine  five 


176    MENTAL  HEALTH  OF  SCHOOL  CHILD 

or  six  pupils  in  an  hour  at  a  given  level  in  the  scale,  as  has 
been  done,  means  partial  and  perfunctory  work,  and  will 
render  the  try-out  essentially  unscientific.  We  cannot 
hope  to  establish  reliable  norms  for  children  by  a  slap-dash 
examination  of  wholesale  quantities  of  pupils.  It  is  better 
to  try  the  scale  out  thoroughly  with  1,000  pupils  than 
partially  with  10,000. 

A  second  way  in  which  to  improve  the  scale,  is  to  under- 
take a  systematic  survey  of  the  intellectual  capacities  of 
normal  boys  and  girls  at  different  ages.  What,  e.g.,  can 
the  typical  six-year-old  or  twelve-year-old  boy  or  girl  do 
intellectually.''  To  answer  this  question  fully  we  need  to 
gather  and  compile  extensive  observational  data  from 
classroom  teachers,  expert  paidologists,  parents  and  intel- 
ligent observers  who  come  into  direct  daily  contact  with 
children. 

At  the  Skillman  institution  I  initiated  an  attempt  to 
gather  such  data  for  the  epileptic  school  children  by  pre- 
paring a  syllabus  on  the  school  efficiency  of  the  pupils. 
School  efficiency  depends  primarily  upon  intellectual  capac- 
ity and  thus  furnishes  an  index  of  intelligence.  From  the 
reports,  made  by  the  teachers,  it  should  be  possible  to  gain 
information  regarding  the  characteristic  intellectual 
capacities  of  epileptics  of  various  chronological  and  Binet- 
Simon  ages  and  of  various  degrees  of  mental  arrest.  The 
information  thus  gathered  should  possess  a  unique  value 
when  brought  into  correlation  with  other  reports  and  the 
various  experimental  tests.  As  soon  as  we  have  extensive 
data  of  this  character  for  large  masses  of  normal  children, 
we  shall  not  only  know  something  definite  regarding  the 
intellectual  capacities  of  children  of  different  ages,  but  we 
shall  have  taken  an  important  step  toward  the  construction 
of  an   adequate  measuring  scale  of  intellectual   develop- 


HUIVIAN  EFFICIENCY  177 

ment.  Such  a  program  of  work  as  this  can  only  be  carried 
to  a  successful  conclusion  by  a  properly  organized  and  a 
well-manned  department  of  clinical  psychology,  or  bureau 
of  research,  in  the  public  schools,  in  a  university  or  in  an 
endowed  private  research  foundation. 

It  is  probably  not  necessary  to  hold  a  brief  in  this  day 
for  the  necessity  of  undertaking  such  a  survey  as  this. 
There  is  a  vast  army  of  repeaters  in  the  schools  which 
threaten  to  become  a  national  menace.  At  the  present 
time,  our  ignorance  concerning,  and  our  neglect  of,  the 
best  care,  treatment  and  education  of  arrested  children, 
stand  out  as  a  national  disgrace.  We  know  little  at 
present  that  is  scientifically  accurate  regarding  the  degree 
or  character  of  the  physical  and  mental  arrest  of  our 
repeaters.  We  do,  therefore,  stand  in  need  of  comprehen- 
sive serial  graded  tests  of  intelligence,  so  that  we  may 
determine,  not  only  the  intellectual  age  of  deviating  chil- 
dren, but  the  nature  of  the  mental  functions  most  seriously 
affected,  and  the  character  of  the  arrest  (whether  per- 
manent or  temporary).  It  is  sheer  folly  to  spend  millions 
of  dollars  trying  to  educate  for  an  intellectual  career 
children  who  are  permanently  retarded.  There  are  in- 
stances on  record  where  arrested  pupils  have  made  prac- 
tically no  progress  during  a  dozen  years  of  schooling,  or 
where  they  have  actually  retrogressed.  We  have  with  us 
nineteen-year-old  epileptics  who  are  doing  second  and  third 
year  work.  We  should  be  able  to  determine  by  means  of  a 
scientific  diagnostic  (intelligence)  scale  (aided  always,  of 
course,  by  comprehensive  'case-studies')  whether  a  given 
subnormal  is  a  custodial  or  institutional  case,  or  a  case 
for  one  of  the  special  classes  in  the  public  schools  (for 
retarded,  blind,  deaf,  mute  children,  etc.).  Binet  has  given 
us  a  'first-aid-to-the-sick'  device,  just  at  the  time  that  we 


178    MENTAL  HEALTH  OF  SCHOOL  CHILD 

are  awakening  to  a  realization  of  the  magnitude  of  the 
problem  of  mental  deficiency. 

While  the  intellectual  measuring  rod  is  fundamental,  we 
stand  in  need  of  a  motor  or  industrial  scale  of  development, 
or  a  combined  intellectual-motor  scale.  This  need  arises 
from  thotfact  that  a  sixteen-year-old  child  chronologically 
may  have  a  twelve-year-old  intellect  and  a  fourteen-j^ear- 
old  musculature.  Such  a  child  is  fairly  strong  muscularly ; 
he  is  able  to  execute  and  coordinate  his  movements  with 
skill ;  he  can  perform  quite  complicated  manual  operations ; 
he  can  master  fairly  difficult  industrial  tasks ;  he  can  retain 
motor  acquisitions  and  form  stable  muscular  habits. 
Although  he  may  be  accounted  an  intellectual  laggard,  he 
ranks  quite  high  in  motor  capacity  and  manual  dexterity — 
a  fact  which  is  being  demonstrated  day  by  day  in  the 
manual  training  and  industrial  classes  in  the  public 
schools.  Such  a  child  would,  then,  be  fairly  normal  on  the 
motor  side. 

Since,  therefore,  the  intellectual  and  the  motor  develop- 
ments will  not  in  all  cases  coincide,  we  need  a  series  of 
motor  diagnostic  tests  arranged  in  a  graded  scale,  in  order 
that  we  may  know  what  a  normal  girl  and  boy  can  do 
industrially,  or  in  motor  performance,  at  different  ages. 
It  should  be  possible  to  construct  such  a  scale  for,  at  least, 
the  periods  of  childhood  and  early  adolescence.  Having 
both  the  intellectual  and  the  motor  scales,  separate  or  com- 
bined, we  shall  be  in  a  position  to  say  whether  the  child's 
defects  involve  in  equal  measure  the  intellectual  and  the 
motor  functions,  or  which  of  these  two  have  suffered  the 
most  impairment,  and  to  what  extent  the  arrest  has  set  in. 
The  pedagogical  value  of  such  a  differential  diagnosis  is 
obvious.  Instead  of  allowing  teachers  to  consume  their 
energies  and  the  energies  of  the  pupils  for  years,  trying  by 


HUMAN  EFFICIENCY  179 

some  sort  of  intellectual  legerdemain  to  fit  round  boys  and 
girls  into  square  holes,  we  shall  be  able  to  prognosticate 
by  means  of  standard  tests  (together  with  accompanying 
exhaustive  clinical  studies)  the  probable  future  pedagogi- 
cal development  of  the  arrested  child,  and  thereby  be  able 
to  plan  a  course  in  which  he  will  make  the  greatest  pro- 
gress. This  will  not  only  redound  to  the  good  of  the  child, 
but  prevent  much  pedagogical  blundering,  loss  of  time  and 
money,  and  vexation  of  spirit. 

Unfortunately  there  is  no  existent  motor  or  industrial 
scale  of  development  for  normal  children  comparable  with 
the  Binet-Simon  intellectual  scale.  At  Skillman  I  had  the 
pleasure  of  launching  an  attempt  to  construct  such  a  scale 
for  epileptics,  by  collecting  extensive  observational  data 
from  the  officers,  supervisors,  attendants  and  employees  of 
the  institution,  bearing  upon  the  industrial  capacities  of 
the  patients  who  are  employed  in  various  forms  of  indoor 
and  outdoor  work.  From  the  results  thus  obtained  it 
should  be  possible  to  construct  a  motor  scale  of  develop- 
ment for  epileptics  for  each  Binet-Simon  age.  (Informa- 
tion is  not  now  available  as  to  whether  these  inquiries  are 
still  carried  on.)  It  is  evident  that  such  a  motor  scale 
would  possess  greater  value  if  we  were  in  a  position  to  turn, 
for  purposes  of  comparison,  to  a  motor  scale  for  normal 
and  supernormal  individuals.  The  need  of  a  normal 
industrial  scale  is  felt  as  keenly  by  the  student  and  trainer 
of  the  special  child,  whether  subnormal  or  supernormal,  in 
the  public  schools,  as  by  the  student  and  trainer  of  institu- 
tional types  of  defectives.  Departments  of  child  study  in 
the  pubhc  schools  and  research  departments  in  institutions 
for  defectives  should  make  an  attempt  to  gather  extensive 
industrial  or  motor  data  by  some  such  means  as  those  we 
are  now  using. 


180    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Finally,  we  must  make  a  survey  of  the  personal  and 
social  traits  and  capacities,  the  moral  characteristics  and 
criminal  tendencies  of  our  patients.  The  data  on  the  per- 
sonal capacities  will  supply  additional  material  for  our 
comparative  measuring  scales.  There  is  need  of  a  similar 
systematic  study  particularly  of  the  moral  and  criminal 
traits  of  the  abnormal,  mischievous  and  delinquent  pupils 
who  people  our  schools,  and  of  the  criminals  who  menace 
our  civilization.  These  data  should  be  secured,  in  the  first 
instance,  for  the  socially  maladjusted  child  in  the  pre- 
adolescent  years,  before  the  criminalistic  tendencies  have 
become  confirmed.  Only  when  we  have  in  our  possession 
extensive  facts  of  this  character  will  we  be  in  a  position  to 
place  our  pedagogical  and  moral  training  and  prophy- 
laxis, and  our  custodial  care  and  treatment  of  abnormal 
and  criminal  individuals  upon  a  satisfactory  basis. 

When  we  have  given  the  same  amount  of  careful,  expert 
study  to  our  normal  and  abnormal  human  population  that 
the  government  is  giving  to  the  study  of  Indian  corn  or 
the  American  hog;  when  we  have  devoted  the  same  scien- 
tific attention  to  the  production  of  superb  brain  crops  that 
experts,  under  government  subsidy,  are  now  giving  to  the 
growing  of  superior  grain  crops :  then  we  may  hope  to 
make  education  a  genuine  science,  and  the  school  and  insti- 
tutional training,  care,  treatment  or  penalization  of  defect- 
ives, dependents  or  criminals  a  real  art.  The  view  that 
public  institutions,  in  addition  to  their  recognized  duties, 
should  function  as  research  laboratories,  is  rapidly  gaining 
acceptance.  Just  now  we  stand  in  great  need  of  extensive 
mass  studies :  a  broad  survey  of  the  total  field  of  human 
capacity.  It  is  with  this  idea  uppermost  that  the  set  of 
efficiency  blanks  at  Skillman  were  prepared  for  the  sys- 
tematic recording  of  observations.     Our  methods  of  inves- 


HUMAN  EFFICIENCY  181 

tigation  must  at  present  necessarily  be  somewhat  crude. 
But  in  time  we  shall  have  just  as  refined  a  technique  for 
studying  the  human  animal  as  we  now  have  for  studying 
chickens  and  pigs. 


CHAPTER  VII 

EIGHT     MONTHS     OF     PSYCHO-CLINICAL     RE- 
SEARCH   AT    THE    NEW    JERSEY    STATE 
VILLAGE  FOR  EPILEPTICS,  WITH  SOME 
RESULTS    FROM    THE    BINET- 
SIMON  TESTING' 

The  functions  of  a  clinical  psychologist  in  an  institu- 
tion for  defectives,  in  a  public  school  system,  in  a  univer- 
sity, in  a  psychiatric  institute  or  in  a  juvenile  court  is 
twofold:  first,  that  of  theoretical  investigation,  or  the 
increase  of  knowledge  under  controlled  and  verifiable  con- 
ditions. This  is  essentially  the  field  of  the  research  psy- 
chologist or  of  pure  science,  so-called.  Second,  that  of 
practical  application,  or  the  utihzation  of  the  truths  dis- 
covered for  the  educational,  hygienic,  medical  and  custodial 
treatment  of  the  sufferers.  This  is  the  work  of  the  con- 
sulting psychologist  as  distinguished  from  the  pure  re- 
searcher, and  constitutes  the  sphere  of  orthogenesis, 
mental  hygiene  or  applied  clinical  psychology.  While  the 
hne  of  demarcation  between  these  two  aims  should  not  be 

1  Read  at  the  tenth  annual  meeting  in  St.  Louis,  Mo.,  of  the 
National  Association  for  the  Study  of  Epilepsy  and  the  Care  and 
Treatment  of  Epileptics,  and  reprinted  from  the  Transactions  of 
the  Association,  1911,  pp.  29-43,  and  from  Epilepsia  (Amsterdam), 
1912,  pp.  366-380.  A  volume  of  studies,  based  on  my  Binet-Simon 
testing  of  epileptics,  will  be  found  in  Experimental  Studies  of  Mental 
Defectives:  A  Critique  of  the  Binet-Simon  Tests,  and  a  Contribution 
to  the  Psychology  of  Epilepsy,  Warwick  &  York,  Inc.,  Baltimore, 
1912. 


PSYCHO-CLINICAL  RESEARCH  183 

made  too  fast  and  hard,  logically  the  work  of  investigation 
in  an  infant  science  naturally  takes  chronological  prece- 
dence to  the  work  of  consultation,  as,  indeed,  science  logi- 
cally precedes  art.  The  art  of  righting  defectives  cannot 
rise  above  the  empirical  until  it  is  based  upon  a  foundation 
of  assured  facts.  Until  we  thoroughly  understand  the  dif- 
ferent types  of  nervous  and  mental  abnormalities  our 
treatment  cannot  be  made  maximally  effective.  For  these 
reasons  the  work  in  the  psycho-clinical  laboratory  at  Skill- 
man  during  the  past  eight  months  has  been  devoted 
entirely  to  investigation. 

During  these  eight  months  a  number  of  Hnes  of  investi- 
gation have  been  started,  some  of  which  have  been  con- 
cluded. Among  the  surveys  of  the  village  which  have  been 
completed  (completed  as  far  as  testing  each  patient  is 
concerned)  are  the  following:  Measurements  of  standing 
and  sitting  heights,  of  weight,  of  lung  capacity,  of  the 
strength  of  right  and  left  hand  grip,  of  station  or  body 
sway,  of  the  speed  of  performing  the  form-board  test 
(replacing  ten  blocks  of  various  forms  in  corresponding 
holes  in  a  board),  of  intellectual  capacity  or  the  extent  of 
intellectual  retardation,  as  evinced  by  the  Binet-Simon 
scale,  and  of  the  rate  of  growth  and  development,  as  well 
as  the  character  and  extent  of  the  deviation  or  disorgani- 
zation of  a  number  of  particular  mental  traits  and  capaci- 
ties which  play  a  basic  role  in  mental  development.  The 
latter  tests  (described  in  Chapter  VI)  when  given  to 
normal  children  are  intended  to  supply  normal  rate  curves 
of  mental  development. 

The  desirabihty,  or  even  the  feasibility,  of  establishing 
psychological  rate  norms  of  development  has,  strangely, 
scarcely  dawned  upon  us  until  recently,  although  the  prac- 
tical value  of  such  norms  is  probably  greater  than  the 


184    MENTAL  HEALTH  OF  SCHOOL  CHILD 

value  of  the  corresponding  anthropometric  standards  of 
yearly  development  during  the  growth-period  of  standing 
and  sitting  height,  weight,  chest  perimetry,  dynamometry 
and  vital  capacity.  The  importance  of  a  set  of  anthropo- 
metric norms,  arranged  on  the  grade  or  percentile  basis, 
has  been  eloquently  set  forth  by  the  lamented  Francis 
Galton,  to  whose  comprehensive  intellect  many  sciences 
have  become  indebted.  Thanks  to  the  labors  of  a  few  of 
Galton's  followers,  notably  Bowditch,  Porter  and  Smedley, 
and  to  the  labors  of  the  Italian  anthropologists,  we  now 
possess  a  set  of  fairly  reliable  physical  development  norms 
and  indices  for  certain  ages,  by  means  of  which  we  are  able 
to  determine  the  physical  station  of  a  given  cliild  of  a  given 
age,  and  by  means  of  which  we  can  say  whether  his  physical 
progress  is  normal  or  satisfactory  as  measured  by  the  per- 
centile grade  for  the  age  to  which  he  belongs  (using  height 
as  the  basis  of  comparison),  and  by  means  of  which  we  can 
determine  the  character  of  his  anthropological  indices. 
But  we  are  now  beginning  to  reahze  that  we  cannot  prop- 
erly diagnose  developmental  defects  of  the  mind  until  we 
have  constructed  a  similar  set  of  psychic  norms  of  develop- 
ment of  various  traits  and  capacities.  When  we  have  such 
norms  for  specialized  capacities  we  shall  be  able  to  locate 
the  mental  station  of  a  given  child  at  a  given  time,  and 
determine  whether  his  rate  of  mental  evolution  is  normal 
for  the  grade  in  which  he  classifies.  These  norms  will 
possess  fundamental  value  for  purposes  of  developmental 
diagnosis,  in  the  study  of  not  merely  the  lesser  deviations 
but  also  the  more  profound  mental  abnormalities.  To 
supply  these  mental  developmental  scales  is  chiefly  a  matter 
of  time,  labor  and  ingenuity ;  the  instrumental  and  techni- 
cal difficulties  are  secondary.  Such  scales  will  not,  of 
course,  attain  the  accuracy  of  refined  physical  measures. 


PSYCHO-CLINICAL  RESEARCH  185 

but  they  will  be  far  superior  to  our  present  'common 
sense'  judgments.  The  fair  degree  of  success  attained  by 
the  simple  Binet-Simon  tests  of  intelligence  justifies  the 
belief  that  this  problem,  baffling  as  it  seems,  is  not  insoluble. 
By  means  of  the  serial  group  tests  which  I  have  been  giving 
during  the  past  year,  I  am  hoping  to  make  some  little 
addition  to  our  knowledge  in  this  largely  unexplored,  but 
inviting  and  important,  field  of  inquiry.  Aside  from  the 
value  which  the  data  from  these  tests  will  have  for  develop- 
mental diagnosis,  the  results  may  also  be  used  as  a  means 
by  which  to  check  up  the  Binet-Simon  tests,  which  have 
recently  come  into  wide  use  in  institutions  for  defectives 
and  in  the  public  schools  in  our  country."  I  turn  now 
to  a  consideration  of  some  of  the  results  of  our  Binet 
testing.  The  space  at  my  disposal  permits  only  a  brief 
reference  to  a  few  of  the  more  obvious  facts,  particularly 
those  which  concern  the  characteristics  of  the  curve  of 
distribution,  or  the  classification  of  the  epileptics  at  Skill- 
man  by  this  method. 

Taking  the  gross  or  group  classification,  the  333 
patients^  included  in  the  cui*ve   (Graph  IV)    classify  as 

2  For  other  studies  undertaken  in  the  psycho-clinical  laboratory 
at  Skillman  during  the  same  year  by  means  of  the  printed  question- 
naire or  syllabus  method,  see  Chapter  VI. 

3  Those  epileptics  were  excluded  from  the  tabulation  who  had  not 
had  a  convulsion  within  a  period  of  two  years,  and  a  few  others 
who  were  not  thoroughly  tested  because  of  certain  sensory  defects. 
The  patients  were  in  their  normal  condition  during  the  tests.  The 
grading  in  all  cases  is  based  upon  the  highest  age  passed,  plus  the 
advance  credits  provided  for  in  the  scale,  irrespective  of  whether 
or  not  the  patient  failed  at  a  lower  level.  Patients  who  passed  in 
two  of  the  thirteen-year  tests  were  credited  with  this  age,  provided 
they  also  passed  at  least  five  tests  in  ages  eleven  and  twelve.  Draw- 
ing one  triangle  was  accepted  for  the  first  of  the  thirteen-year-old 
tests. 


186    MENTAL  HEALTH  OF  SCHOOL  CHILD 

follows:  5.7  per  cent  are  idiots  (mentality  of  one  and  two 
years),  27.3  per  cent  are  imbeciles  (mentality  of  ages 
three  to  seven),  61.5  per  cent  are  morons  (mentality  of 
ages  eight  to  twelve),  5.4  per  cent  have  a  mentality  of 
thirteen  years  or  over  (see  the  table  and  the  curve),  and 
82.8  per  cent  have  a  mentahty  of  less  than  eleven  years. 
The  idiots  and  thirteen-year  olds  are  about  equally  infre- 
quent, while  the  morons  are  decidedly  preponderant. 
These  results  will  attain  a  new  significance  if  we  compare 
them  with  the  Binet  curve  for  378  feeble-minded  inmates 
at  Vineland.* 

In  this  19.2  per  cent  grade  as  idiots ;  54  per  cent  as 
imbeciles ;  26  per  cent  as  morons ;  none  as  thirteen  years 
of  age;  and  96.4  per  cent  less  than  eleven  years  of  age. 
The  feeble-minded  idiots  are  about  three  and  one-half  times 
as  numerous  as  the  epileptic  idiots,  but  the  epileptic 
morons  are  more  than  two  and  one-half  times  as  numerous 
as  the  feeble-minded  morons.  While  the  great  mass  of 
epileptic  and  feeble-minded  defectives  have  a  mentality  of 
less  than  eleven  years,  the  proportion  is  13.6  per  cent 
greater  among  the  feeble-minded  than  among  the  epilep- 
tics. The  typical  epileptic  category  is  that  of  the  con- 
dition of  moronity,  which  contains  five-eighths  of  the 
entire  number  of  the  epileptics,  while  the  typical  feeble- 
minded station  is  that  of  imbecility,  which  includes  more 
than  one-half  of  the  feeble-minded.  It  is  apparent  that 
there  is  a  marked  difference  between  epileptic  degenerates 
and  feeble-minded  retardates  in  the  matter  of  intelligence. 

4  GoDDARD.  Journal  of  Psycho-Asthenics,  1910,  15:  Nos.  1  and 
2.  The  per  cents  for  each  age  for  the  feeble-minded  are  as  follows: 
Age  I,  9.5  per  cent;  II,  9.7  per  cent;  III,  10.5  per  cent;  IV,  9.8  per 
cent;  V,  11.1  per  cent;  VI,  10.2  per  cent;  VII,  12.4  per  cent;  VIII, 
11.6  per  cent;  IX,  7.9  per  cent;  X,  3.7  per  cent;  XI,  1.3  per  cent; 
XII,  1.8  per  cent.     Age  X  in  the  curve  is  placed  somewhat  too  high. 


Graph  IV 

Classification  of  333  epileptics   (Skillman)   and  378  feeble- 
minded (Vineland)  by  the  Binet-Simon  method. 


26 
20 
15 
10 
5 

^~' 

H^B 

J 

i 

i 

\\ 

1 
1 

1  < 

i        \ 

^' 

^>.. 

/ 

f 

\      \ 

.-• 

r 

V 

r 

J 

\! 

/ 

I 
\ 

f 

I 

/ 

\ 

\ 

/ 

\ 

\ 

/ 

\ 

\ 

I 

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\ 

/ 

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[ 

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1 

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— ' 

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^^ 

. 

_J 

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%, 

Ages              5                       10 

Epileptics    .  .  . 
Feeble-minded 


Idiots 
Per  cent 

5.7 
19.2 


Imbeciles 
Per  cent 

27.3 
54.0 


Morons 
Per  cent 

61.5 
26.0 


Per  Cent 
5.4 
0.0 


The  thirteen-year-olds  may  be  classed  as  deviates,  retard- 
ates or  normals. 


188    MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  intellectual  superiority  of  the  epileptic  defective  is 
conspicuous.  This  superiority  will  attain  added  promi- 
nence if  we  constitute  the  thirteen-year-olds  into  a  separate 
class  above  the  feeble-minded  line,  which  we  may  regard 
as  normal,  or  as  retarded  or  deviating  but  not  sufficiently 
to  render  them  feeble-minded.  We  should  then  have  to  add 
to  this  class  all  the  children  who  are  retarded  less  than 
three  years  (certainly  many  adolescent  children  retarded 
less  than  three  years  would  not  be  feeble-minded).  There 
are  nine  of  these,  five  boys  and  four  girls.  These  with 
the  thirteen-year-olds,  make  a  total  of  twenty-seven 
normals,  or  deviates,  which  is  8.1  per  cent  of  the  entire 
group.  ^ 

This  figure  we  are  justified,  I  believe,  in  regarding  as 
a  lower  limiting  value  for  two  reasons.  First,  the  tests  in 
the  liigher  ages  are  very  probably  too  difficult  for  the 
typical  American  child  for  the  ages  to  which  they  are 
assigned. 

To  get  a  line  on  these  higher  tests  I  made  use  of  the 
following  means.  A  few  of  the  supervisors  and  officers  at 
Skillman  who  had  known  the  patients  intimately  for  a  con- 
siderable length  of  time  were  asked  to  prepare  estimates 
of  the  number  of  patients  whom  they  regarded  as  ranking 
above  the  feeble-minded  station.  Three  made  identical 
estimates,  unknown  to  each  other,  for  the  total  population, 
namely  10  per  cent.  Five  men  made  separate  and  inde- 
pendent estimates  of  the  total  male  population,  as  follows : 
11,  11,  13,  14  and  20  per  cent.  With  one  exception,  these 
estimates  agree  fairly  well.  With  the  tests  as  at  present 
constituted,  it  is   a  question  whether   the  line  of  feeble- 

5  It  is  interesting  to  note,  that  among  these  twenty-seven  there  is 
only  one  who  can  be  regarded  as  supernormal,  a  boy  somewhat  less 
than  twelve  years  who  grades  as  thirteen  years. 


PSYCHO-CLINICAL  RESEARCH  189 

mindedness  should  be  drawn  (if  indeed  it  can  be  definitely 
drawn  anywhere)  between  twelve  and  thirteen,  as  has  been 
tentatively  done  by  the  American  Association  for  the 
Study  of  Feeble-Mindedness.  A  number  of  our  twelve- 
year-olds  are  certainly  very  slightly,  if  at  all,  feeble- 
minded. 

A  second  reason  why  the  percentage  of  normals  may 
be  too  low  is  the  fact  that  the  institutional  cases  at  Skill- 
man  may  not  be  representative.  Our  curve  in  general  is 
valid  on  the  assumption  that  the  epileptics  tested  are 
typical.  According  to  the  theory  of  the  probability  sur- 
face we  are  justified  in  regarding  them  as  typical  if  the 
selection  represents  a  chance  distribution.  But  it  is  possi- 
ble that  two  selective  processes  have  operated  in  a  way  to 
distort  both  extremes  of  the  curve.  The  reason  that  the 
idiots  are  so  few  may  be  due  to  the  fact  that  the  higher- 
grade  epileptics  have  received  preference  in  admission  to 
the  institution.  The  introduction  of  a  constant  factor  of 
this  sort  would  skew  the  frequency  curve  in  the  direction 
of  the  upper  limit.  This  tendency  would  probably  stop 
short,  however,  before  it  reached  the  extreme  end  of  the 
curve,  because  it  is  likely  that  the  highest  grade  of  epilep- 
tics from  the  better  social  classes  are  very  rarely  found  in 
public  institutions.  We  shall  not  be  able  definitely  to 
settle  this  point  until  other  institutions  have  undertaken 
similar  studies  on  a  large  scale.  But  three  general  con- 
clusions seem  assured :  first,  that  the  great  mass  of  epilep- 
tics fall  below  the  feeble-minded  line ;  second,  that  they  do 
not  fall  below  this  line  to  such  an  extent  as  the  class  of 
amented  feeble-minded ;  and  third,  that  the  curve  of  dis- 
tribution is  markedly  different  for  the  two  classes.  Just 
how  much  inferior  the  high-grade  epileptics  are  to  those 
persons,  taken  at  random  in  the  general  population  whose 


190    MENTAL  HEALTH  OF  SCHOOL  CHILD 

schooling  and  training  are  about  of  the  same  character, 
cannot  now  be  said. 

One  of  the  most  striking  pecuHarities  of  the  epileptic 
curve  is  its  decidedly  skewed  or  anomalous  character, 
noticeable  particularly  between  ages  eight  and  eleven. 
The  curve  presents  a  marked  contrast  with  the  curve  of 
feeble-mindedness  in  this  respect.  The  latter  is  character- 
ized by  a  fairly  uniform  rise  up  to  and  including  age  seven, 
and  by  a  rapid  and  uniform  fall  after  age  eight.  It  has 
more  or  less  of  the  normal  bell-shaped  appearance.  But 
in  the  epileptic  curve  there  are  two  irregular  drops  in  the 
ascending  portion,  a  minor  at  five  and  a  major  at  nine. 
The  former  does  not  possess  much  significance,  because  of 
the  small  number  of  subjects  tested  in  the  lower  ages.'  It 
may  be  regarded  merely  as  a  fortuitous  phenomenon.  But 
in  a  typical  curve  of  frequency  the  rise  from  age  six 
should  have  been  continued  without  any  marked  break  at 
nine  to  the  apex  at  ten.  It  is,  therefore,  apparent  that  the 
accidental  factors  which  normally  operate  to  produce  an 
unskewed  or  bell-shaped  curve  of  frequency,  were  inter- 
fered with  in  our  testing  by  some  constant  factor  or 
factors.  These  factors  can  only  reside  in  the  method  of 
gi\4ng  the  tests,  or  in  the  nature  or  arrangement  of  the 
tests  themselves,  or  in  the  peculiar  mental  organization 
of  the  epileptics  resulting  from  their  inborn  constitution 
or  from  processes  of  degeneration.*' 

There  must  either  be  certain  defects  in  the  mentality  of 
epileptics,  that  is,  at  the  nine-year  level,  for  we  find  24.9 
per  cent  of  epileptics  grading  ten  years  old  as  against 

6  Another  factor  may  have  to  be  considered,  the  relative  propor- 
tion of  children  among  the  epileptics  and  feeble-minded.  One-third 
of  the  epileptics  were  under  twenty-one  years  of  age;  the  correspond- 
ing figure  for  the  feeble-minded  is  54  per  cent. 


PSYCHO-CLINICAL  RESEARCH  191 

only  8.4  per  cent  grading  nine  years  old ;  or  we  must  con- 
sider the  ten-year-old  tests  as  normally  too  easy  and  the 
nine-year  tests  as  too  difficult ;  or  otherwise  some  factor 
extraneous  to  the  tests  themselves  has  been  operative. 

The  method  of  testing  possibly  plays  a  minor  role,  for 
while  the  method  used  has  followed  that  in  vogue  at  Vine- 
land,  there  is  this  possible  difference:  my  testing  has  been 
done  with  great  thoroughness  in  this  respect,  that  instead 
of  confining  the  testing  of  the  patients  to  the  ages  imme- 
diately beneath  or  above  the  ages  in  which  they  grade,  I 
have  tested  the  majority  throughout  the  greater  part  of 
the  scale.  This  was  done,  not  merely  to  arrive  at  a  more 
complete  clinical  picture — to  reveal  the  peculiar  mental 
lapses,  gaps  and  remnants  which  may  be  assumed  to  ac- 
company degeneration  changes — but  in  order  to  test  the 
reliability  of  the  scale  itself.  For  this  purpose  nothing  but 
a  thoroughgoing  try-out  will  suffice.^ 

This  thorough  testing  has  given  some  interesting  results, 
which  we  cannot  enter  upon  here  further  than  to  say  that 
s"cores  of  low  or  medium  grade  epileptics  were  found  who 
passed  one  or  more  tests  in  a  half  dozen  higher  age  levels, 
and  who  received  from  ten  to  twenty  (in  a  few  cases  from 
twenty-five  to  thirty)  advance  points  from  the  first  age 
actually  passed.  Certain  mental  remnants  from  higher 
psychic  levels  remained  to  tell  the  story  of  the  wreckage 
wrought  by  the  disease.  At  the  same  time,  scores  who 
passed  the  .higher  age  tests  failed  in  indi^ddual  tests  at 
lower  levels.  Two  years  particularly  proved  veritable 
pontes  asinorum,  namely  ages  six  and  nine.  No  per  cent  of 
those  who  are  classified  in  age  six  passed  the  tests  of  this 
age  (that  is,  all  the  tests  or  aU  but  one),  while  only  10  per 

7  Such  a  try-out  must  be  made,  of  course,  primarily  on  large 
masses  of  normal  children. 


192    MENTAL  HEALTH  OF  SCHOOL  CHILD 

cent  of  the  Binet-Siraon  nine-year-olds  passed  the  tests  of 
this  year.  Only  29  per  cent  of  the  groups  of  patients  who 
grade  six,  seven,  eight,  nine  and  ten  years  old  passed  the 
six-year-old  tests,  while  only  40  per  cent  of  the  nine,  ten, 
eleven,  twelve  and  thirteen  year  olds  passed  the  nine-year 
tests.  But  what  is  of  special  interest  to  the  question  at 
issue  now  is  the  fact  that  the  method  of  extensive  testing 
used  made  it  possible  for  patients  to  attain  a  different  or 
higher  classification  on  the  basis  of  advance  credits  from 
numerous  higher  ages.  That  is  why  there  is  no  fall  in  the 
curve  at  six,  e.g.,  although  not  a  single  one  of  the  six-year- 
olds  actually  passed  all  of  the  tests  but  one  of  that  age. 
While  this  factor  is  thus  of  some  importance,  it  does  not 
explain  why  there  is  such  a  large  number  of  ten-year-old 
patients,  because  the  greater  number  of  these  (94  per 
cent)  passed  the  ten-year-old  tests  while  84  per  cent  of 
them  failed  on  the  nine-year  tests.  There  is  some  evidence 
to  confirm  the  belief  that  the  nine-year  tests  are  too  diffi- 
cult: the  first  obvious  break  in  the  curve  of  feeble-minded- 
ness  comes  at  this  age,  while  Katherine  Johnstone,®  testing 
a  considerable  group  of  normal  girls  in  the  Sheffield,  Eng- 
land, schools,  found  this  year  to  be  the  most  difficult. 
After  making  due  allowance  for  these  two  factors — the 
thoroughness  of  the  testing,  and  the  intrinsic  difficulty  of 
the  tests  themselves — the  facts  would  seem  to  force  us  to 
include  a  third  factor.  A  detailed  analysis  of  the  records, 
and  particularly  of  the  failures  at  various  levels,  shows 
that  the  inability  to  pass  ages  six  and  nine  (eleven  may 
also  be  included)  is  due,  at  least  partly,  to  certain  inherent 
defects  in  the  epileptic  mind.     These  defects,  so   far  as 

8  Katherine  L.  Johnstone.  Journal  of  Experimental  Pedagogy, 
l:24f.  (She  also  finds  that  some  normal  cliildren  pass  higher  levels 
while  failing  at  inferior  levels.) 


PSYCHO-CLINICAL  RESEARCH  193 

pertains  to  these  ages,  arise:  first,  from  a  fundamental 
deficiency  in  memory  span,  as  shown  by  the  inability  to 
repeat  a  sentence  of  sixteen  syllables  heard  once,  to  recall 
six  units  or  facts  from  reading  a  short  passage  once,  and 
to  correctly  state  their  ages  in  years ;  second,  from  an 
inability  to  define  common  objects  in  terms  of  description 
or  classification,  or  to  define  simple  abstract  qualities  in 
terms  of  the  essential  idea ;  third,  from  a  blunting  of  the 
muscular  sensibility,  or  a  raising  of  the  threshold  of  mus- 
cular sensory  discrimination  of  weight ;  fourth,  from  a  fail- 
ure to  grasp  the  essentials  of  a  simple  situation,  as 
evidenced  by  the  inability  to  execute  a  simple  triple  com- 
mand, or  to  arrange  shuffled  words  into  an  intelligible 
sentence ;  and  fifth,  from  a  marked  obstruction  or  retarda- 
tion of  the  stream  of  thought,  as  evidenced  by  the  inability 
to  utter  sixty  words  in  three  minutes. 

From  the  very  fragmentary  account  which  we  have  thus 
given  of  certain  aspects  of  our  Binet  work,  we  are  able  to 
frame  a  picture  of  an  interesting  spectacle :  a  case  of 
mental  wreckage^  whereby  the  integrity  of  various  mental 
functions  has  been  impaired  in  various  levels  of  mental 
development,  and  whereby  various  lower  psychic  levels  have 
been  swept  away  while  higher  levels  remain  intact.  The 
mentality  of  epileptics  makes  up  a  constellation  that  is 
extremely  irregular.  To  what  extent  the  minds  of  the 
epileptic  males  differ  from  the  females,  and  the  children 
from  the  adults,  as  determined  by  the  Binet  scale,  time  does 
not  permit  us  to  discuss.  Nor  can  we  detail  the  interesting 
results  obtained  by  plotting  age  curves  (for  the  thirteen 
Binet  ages)  for  various  individual  tests  by  which  it  appears 
that,  although  the  scale  surely  does  not  accurately  meas- 
ure every  individual,  it  is,  in  the  hands  of  the  expert,  a 
surprisingly  serviceable  means  of  classifying  homogeneous 


194    MENTAL  HEALTH  OF  SCHOOL  CHILD 

masses  or  groups  of  individuals.  These  can  all  be  graded 
relatively  by  means  of  a  uniform  measuring  rod.  To  this 
statement  we  must  except  the  highest  grade  epileptics, 
however.  The  capacities  of  a  considerable  number  of 
these  He  outside  of  the  range  of  the  scale.  Altogether,  the 
Binet-Simon  scale  offers  an  ingenious  but  simple,  practic- 
able, objective  and  rapid  device  for  estimating  and  classi- 
fying defectives.  No  other  available  scheme  gives  such  a 
satisfactory  preliminary  survey.  It  can  tell  us  in  one  hour 
facts  regarding  new  admissions  which  would  otherwise 
come  only  after  weeks  of  observation  and  experience.  To 
an  audience  of  this  kind,  the  great  need  of  a  practical  and 
simple  means  of  grading  and  classifying  institutional  cases, 
and  the  conspicuous  present  lack  of  a  generally  accepted 
or  satisfactory  method  need  not  be  emphasized.  It  is 
pertinent  to  lay  stress  on  the  fact  that  the  Binet  method 
marks  a  decided  advance  step,  in  spite  of  all  its  imperfec- 
tions. Supplemented  by  corresponding  scales  of  personal, 
social  and  industrial  efficiencies,  this  scheme  of  graded 
intelligence-tests  offers  considerable  aid  in  the  solution  of 
a  vexing  problem. 


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CHAPTER  VIII 

THE  PRESENT  STATUS  OF  THE  BINET-SIMON 
GRADED  TESTS  OF  INTELLIGENCE' 

The  Binet-Simon  graded  tests  of  intellectual  develop- 
ment, or  similar  amplified  and  standardized  tests,  give 
promise  of  making  so  large  a  contribution  to  the  methodo- 
logical technique  indispensable  in  the  scientific  study  of  all 
sorts  of  mentally  deviating  and  defective  individuals,  that 
too  much  time  cannot  be  devoted  to  the  critical  examina- 
tion of  the  tests,  in  order  to  determine  the  accuracy  and 
relevancy  of  the  scale.  It  is  no  less  necessary  in  psycho- 
logical than  in  medical  or  biological  investigations  to 
rigorously  adhere  to  the  accepted  rule  in  the  physical 
sciences,  that  before  making  any  measurements  whatever 
it  is  necessary  to  determine  whether  the  instruments  of 
research  are  accurate,  and  if  not  what  the  amount  of  the 
inaccuracy  is. 

There  are  at  least  four  methods  available  by  means  of 
A\hich  we  may  test  the  accuracy  of  measuring  scales  of 
intellectual  capacity. 

The  f.rst  method  is  to  test  masses  of  supposedly  normal 
children,  and  determine  the  percentage  of  passing  for 
each  test  in  each  age-norm  or  for  each  collective  age-norm. 
At  the  present  time  we  have  the  returns  from  a  number  of 

1  Read  before  the  American  Psychological  Association,  at  the  Wash- 
ington meeting,  December  27,  1911.  Reprinted  from  The  Alienist  and 
Neurologist,  May,  1913. 


BINET-SIMON  GRADED  TESTS  197 

scattered  surveys  made  by  the  Binet-Simon  method  in 
France  (Binet  and  Simon),  Belgium  (Decroly  and  De- 
gand),  England  (Katherine  Johnstone),  America  (God- 
dard)  and  Germany  (Bobertag).  These  studies  represent 
much  painstaking  work,  and  are  valuable  contributions. 
But  they  are  more  or  less  unsatisfactory  for  various  rea- 
sons. The  number  of  children  tested  in  each  age,  at  least 
in  some  ages,  has  been  rather  limited.  In  the  absence  of 
any  definite  criterion  by  which  to  select  a  normal  or  typical 
or  average  child,  the  children  tested  have  been  largely 
selected  at  random.  And  the  testing  has  usually  been  of 
the  narrow-range  type.  By  a  narrow-range  type  of 
testing  I  refer  to  surveys  which  are  limited  to  the  child's 
chronological  age  and  one  or  two  higher  and  lower  ages. 
Such  limited  surveys  made  on  a  small  number  of  children 
are  practically  worthless  for  the  purpose  of  arriving 
at  an  adequate  clinical  picture  of  the  child's  mental  condi- 
tion, or  for  determining  his  mental  status,  or  for  the  pur- 
pose of  trying  out  the  accuracy  of  the  scale,  because  from 
all  that  we  know  about  human  nature  from  a  number  of 
psychological  and  pedagogical  investigations,  mental 
traits,  whether  original  or  acquired,  differ  very  consider- 
ably in  children  of  the  same  chronological  ages  or  of  the 
same  school  classification.  The  defectiveness  of  restricted 
testing  has  been  forcibly  brought  home  to  me  from  my  own 
wide-range  testing  of  a  colony  of  epileptics,  and  from  a 
less  extensive  testing  of  certain  types  of  insane  patients. 
From  the  wide-range  method  of  testing  epileptics  with  the 
Binet-Simon  scale  it  appeared  that  dozens  of  those  who 
were  only  able  to  pass  one  of  the  lower  age-standards 
passed  one  or  more  tests  in  a  half  dozen  higher  ages,  and 
several  of  those  who  failed  on  the  age  standards  between 
six  and  nine  passed  age  ten.     It  is  necessary  to  remember 


198    MENTAL  HEALTH  OF  SCHOOL  CHILD 

in  the  later  discussion  that  the  surveys  thus  far  made  on 
pubhc  school  children  have  usually,  perhaps  nearly  always, 
followed  the  narrow-range  method  of  testing  (the  writers 
have  given  little  information  to  the  pubhc  on  this  impor- 
tant point). 

It  is  important  to  raise  the  question  as  to  whether  a 
try-out  of  the  tests  to  prove  thoroughly  satisfactory  must 
not  be  based  on  fairly  normal  or  typical  children,  and  not 
on  mixed  groups  of  normal,  subnormal  and  supernormal 
children.  Even  among  normal  children,  so-called,  we  shall 
always  find  a  considerable  amount  of  variation  in  the 
strength  of  any  trait  or  capacity;  but  if  we  include  both 
dull  and  bright  children  the  variation  becomes  so  large 
that  the  survey  can  scarcely  be  used  for  the  purpose  of 
testing  the  rehability  of  the  scale.  It  may  be  frankly  con- 
ceded that  we  have  no  fixed  standard  of  what  constitutes 
the  normal  child  in  any  age,  but  we  are  in  a  position  to 
use  a  fairly  satisfactory  criterion  by  wliich  to  select 
average  children,  namely,  the  degree  of  pedagogical 
arrest  or  progress  which  the  child  has  shown  in  his  school 
work  and  the  number  of  physical  defects  found  by  careful 
medical  inspection. 

A  second  method  by  which  to  test  the  accuracy  of  scales 
of  mental  development  is  to  test  the  same  groups  of 
normal  children  annually.  If  the  scale  is  measurably 
correct  the  children  should  gain  approximately  one  mental 
age  with  the  passing  of  each  calendar  year.  No  detailed 
studies  of  this  sort,  on  normal  children,  made  by  the 
Binet-Simon  scale,  have  yet  been  published,  so  far  as 
I  am  aware. 

A  third  method  is  to  classify  by  mental  ages  all  the 
members  of  homogeneous  groups  of  individuals,  such  as 
entire  colonies  of  epileptics  or  entire  institutions  for  the 


BINET-SIMON  GRADED  TESTS  199 

feeble-minded  or  the  insane.  The  curves  of  distribution 
or  surfaces  of  frequency  from  such  surveys  should,  from 
the  theory  governing  distributions  controlled  by  chance 
factors,  assume  the  normal,  bell-shaped  appearance.  In  a 
homogeneous  group  (at  least  of  persons  who  have  reached 
maturity)  the  mental  stations  of  the  individuals  should 
cluster  around  one  mode.  From  this  mode  approximately 
equal  negative  and  positive  departures  would  occur.  The 
frequency  of  the  departures  would  depend  upon  their  size ; 
the  larger  the  departure,  the  smaller  the  frequency.  The 
curve,  accordingly,  will  taper  off  in  the  form  of  a  bell ;  and 
if  any  marked  skews  occur  it  is  evident  that  the  group  in 
question  is  not  a  typical  group — the  group  is,  so  to  say, 
a  loaded  group  because,  certain  factors  having  received 
undue  emphasis  in  its  selection,  the  law  applying  to  chance 
distributions  does  not  hold — or  the  size  of  the  group  is  too 
small  to  furnish  reliable  data,  or  there  are  inequalities  or 
irregularities  in  the  measuring  scale  or  in  the  method  of 
testing,  or  the  group  is  so  peculiar  or  anomalous  as  not 
to  be  in  accordance  with  Gauss'  curve.  Two  Binet-Simon 
cui*ves  of  distribution  have  been  constructed  for  homo- 
geneous groups  of  individuals,  and  are  available  for  tliis 
study. 

A  fourth  method  of  evaluation  is  to  plot  efficiency  or 
capacity  curves  for  each  separate  trait  in  all  the  mental 
ages  in  which  the  given  trait  has  been  tested.  If  the 
individuals  of  a  given  group,  whether  normal  or  abnormal, 
have  been  classified  with  approximate  accuracy  by  the 
scale,  then  we  should  expect  a  gradual  rise  in  the  efficiency 
or  capacity  curve  with  each  higher  mental  age,  or  at  least 
with  every  second  or  third  higher  age.  Thus  the  children 
classifying  as  of  six  years  of  age  ought  to  be  able  to 
repeat   more   detached  words   in  three  minutes   than   the 


200    MENTAL  HEALTH  OF  SCHOOL  CHILD 

children  grading  five,  and  the  seven-year-olds  more  than 
the  six-year-olds,  etc.  Moreover,  instead  of  testing  the 
relevancy  of  the  scale  by  plotting  efficiency  age  curves 
merely  for  the  traits  which  are  tested  in  the  scale  itself, 
we  may  employ  extraneous  tests.  Thus  if  the  children  have 
been  properly  classified  by  the  scale  we  should  expect  those 
who  grade  eight  mentally  to  replace  the  blocks  in  a  form- 
board  more  rapidly  than  those  who  grade  six  or  seven, 
and  so  on.  This  would  not  hold  true,  of  course,  for  every 
individual,  but  it  should  hold  for  masses  of  individuals. 
The  gradual  increase  of  efficiency  or  capacity  may  be 
expected  to  continue  up  to  the  point  where  the  trait  in 
question  reaches  its  maturity  or  maximal  development. 
This  will  be  followed  by  a  period  of  stationary  efficiency 
which  will  continue  to  the  beginning  of  the  period  of 
decline  or  of  involution  changes. 

In  the  case  of  curves  which  are  based  on  abnormal  per- 
sons, such  as  epileptics,  the  feeble-minded  and  the  insane, 
the  validity  of  this  method  of  testing  the  accuracy  of  the 
scales  may  be  questioned.  But  it  seems  reasonable  to  sup- 
pose, and  the  supposition  is  in  accordance  with  such  evi- 
dence as  we  have,  that  if,  say,  fifty  epileptics  grade  eight 
mentally,  fifty  grade  nine  and  fifty  grade  ten,  the  average 
efficiency  of  a  given  trait  will  be  less  for  the  eight-  than 
the  nine-year  group,  and  less  for  the  nine-  than  the  ten- 
year  group.  Hence  the  legitimacy  of  the  method  can 
scarcely  be  questioned  so  far  as  concerns  the  testing  of 
the  reliability  of  the  scale  for  classifying  the  individuals 
of  a  given  homogeneous  group.  Moreover,  if  we  grant  the 
contention  that  the  individuals  of  the  human  race  (the 
idiots  possibly  excepted)  are  not  classifiable  into  disparate 
groups  or  classes,  separated  by  distinct  gaps,  but  that 
they  differ  merely  in  degree — quantitatively,  not  qualita- 


BINET-SIMON  GRADED  TESTS  201 

tively — so  that  all  can  be  ranged  on  a  common  surface  of 
frequency  in  respect  to  any  trait  or  combination  of  traits 
which  may  be  tested,  then  we  may  assume  that  the  strength 
of  different  mental  traits  in  a  group  of  abnormal  indi- 
viduals who  classify,  say,  as  nine  mentally,  should  be 
approximately  the  same  as  in  a  group  of  normal  persons 
who  classify  as  nine.  This  would  not  hold  for  every  pos- 
sible trait,  but  probably  would  hold  for  the  average  of  the 
various  traits  tested  in  the  same  age.  It  has  been  neces- 
sary thus  to  advert  to  these  premises  because  no  graded  or 
age  growth  curves  for  individual  traits  have  thus  far  been 
plotted  with  a  view  to  testing  the  relevancy  of  the  scale, 
save  those  to  which  reference  will  be  made  in  this  paper. 

What,  now,  do  the  results  of  the  surveys  made  by  vari- 
ous workers  indicate  with  respect  to  the  correctness  of  the 
Binet-Simon  scale?  The  space  at  our  disposal  makes  it 
necessary  to  limit  the  discussion  to  a  very  brief  recapitula- 
tion of  a  more  extended  monographic  treatment.^  We 
shall  take  up  first  of  all  the  curves  of  distribution. 

In  my  plotting  of  a  curve  of  distribution  (Graph  IV, 
p.  187)  for  a  homogeneous  group  of  mentally  impaired 
persons  (epileptics),  two  obvious  skews  attract  the  eye, 
a  minor  one  at  five  and  a  major  one  at  nine.  The  drop  in 
the  frequency  at  five  is  negligible,  for  reasons  that  cannot 
be  entered  into  here,  but  the  drop  at  nine  clearly  appeared 
to  be  abnormal.  Only  8.4  per  cent  of  the  epileptics  graded 
nine  years  while  24.9  per  cent  graded  ten  years  mentally. 
A  minute  analysis  of  the  data  indicated  that  the  irregu- 
larity at  nine  could  be  traced  to  four  causal  factors :  the 
wide-range    method   of    testing,    the    method    of   scoring, 

2  Experimental  Studies  of  Mental  Defectives:  A  Critique  of  the 
Binet-Simon  Tests,  and  a  Contribution  to  the  Psychology  of  Epilepsy, 
Warwick  and  York,  Inc.,  1912. 


202    MENTAL  HEALTH  OF  SCHOOL  CHILD 

inherent  inequalities  or  anomalies  in  the  mental  make-up 
of  epileptics,  and  inherent  inequalities  or  defects  in  the 
Binet-Simon  scale  itself.  Of  these  factors  the  last  two 
were  far  and  away  the  most  important. 

The  above  skews  in  the  curve  furnished  presumptive 
evidence  that  the  scale  was  not  maximally  correct.  This 
presumption  was  abundantly  confirmed  by  a  further  analy- 
sis of  the  data,  which  showed  that  several  age-standards 
were  entirely  too  difficult,  more  particularly  ages  six  and 
nine.  It  was  discovered,  for  example,  that  none  of  those 
who  are  classified  as  of  age  six  were  able  to  qualify  on  this 
age-norm  (i.e.,  pass  all  the  tests  but  one)  :  they  all  made 
the  six-year  standard  on  the  basis  of  advance  credits. 
Only  29  per  cent  of  those  who  grade  six,  seven,  eight,  nine 
and  ten  passed  the  six-year  standard.  Similarly  only 
10  per  cent  of  the  Binet-Simon  nine-year-olds,  and  only  40 
per  cent  of  all  those  grading  from  nine  to  thirteen,  passed 
the  nine-year  standard.  These  results  for  epileptics,  taken 
by  themselves,  would  be  suggestive  although  possibly  not 
convincing.  But,  unfortunately,  similar  inequaHties  in  the 
age-standards  appear  in  the  pubHshed  data  based  on  the 
testing  of  public  school  children.  In  Katherine  Johnstone's 
testing  of  public  school  girls  in  England  (Sheffield), 
twenty-four  out  of  thirty  nine-year-olds  failed  on  the  nine- 
year  norms ;  and  in  Goddard's  testing  of  school  children  in 
our  own  country,  the  number  of  six-year-olds  who  were 
able  to  satisfy  the  seven-year  norms  was  larger  than  the 
number  who  passed  age  six,  a  larger  number  of  eight-year- 
olds  stayed  in  age  seven  than  made  age  eight,  more  nine- 
year-olds  were  able  to  pass  the  ten-  than  the  nine-year 
norm,  an  unusually  large  number  of  ten-year-olds  qualified 
on  the  standard  for  this  age  while  a  much  smaller  per- 
centage of  eleven-year-olds  could  pass  the  standard  of  that 


BINET-SIMON  GRADED  TESTS  203 

age,  and  more  twelve-year-olds  classified  as  ten  than  as 
twelve. 

These  relative  disproportions  in  the  collective  difficulty 
of  the  different  age-norms  are,  of  course,  ultimately  de- 
pendent on  inequalities  or  misplacements  of  the  individual 
tests  which  make  up  a  given  age-norm.  When  the  results 
are  critically  examined  it  is  found,  as  a  matter  of  fact,  that 
there  is  an  amazing  lack  of  uniformity  between  the  differ- 
ent tests  of  the  same  age.  The  extent  of  this  inequahty 
may  be  expressed  in  quantitative  terms  by  the  average 
mean  variations  between  the  percentages  of  successes  for 
all  the  tests  of  the  same  ages.  No  mean  variations  have 
been  computed  except  for  a  colony  of  epileptics.  For  the 
epileptics  the  M.  V.'s  amount  to  over  .20  in  four  ages 
(I-II,  III,  VII,  IX),  and  less  than  .14  in  six  ages  (V,  VI, 
VIII,  X,  XI,  XII),  while  the  average  for  the  thirteen  ages 
amounts  to  .17. 

Similarly  the  differences  between  the  easiest  and  most 
difficult  tests  in  the  same  ages,  based  on  the  performances 
of  the  epileptics  who  classify  in  the  given  ages,  amount  to 
as  much  as  62  per  cent  in  age  six,  57  per  cent  in  age  twelve 
and  56  per  cent  in  age  nine;  while,  correspondingly,  the 
smallest  ranges  are  11,  21  and  24  per  cent  for  ages  four, 
eight  and  one,  respectively.  It  is  thus  evident  that  most 
of  the  age-norms  contain  tests  varying  conspicuously  in 
difficulty.  Some  are  too  difficult,  some  too  easy  and  others 
about  right. 

Here,  again,  the  findings  among  epileptics  are  par- 
alleled in  the  results  of  the  public  school  testing.  Limita- 
tions of  space  render  it  quite  impossible  to  indicate  the 
status  of  all  the  tests  in  the  scale.  I  shall,  therefore,  only 
take  space  to  mention  some  of  the  tests  which  most  ob- 
viously appeared  in  my  own  testing  to  be  misplaced,  and 


204    MENTAL  HEALTH  OF  SCHOOL  CHILD 

which  Kkewise  proved  to  be  improperly  located  when 
judged  by  the  testing  of  ordinary  runs  of  public  school 
children. 

Among  the  tests  which  have  proved  to  be  too  difficult 
for  the  age  to  which  they  have  been  assigned  are  the 
following : 

Age  V,  rearranging  triangles.  Age  VI,  repeating  six- 
teen syllables.  Age  VIII,  copying  a  dictated  phrase.  Age 
IX,  giving  correct  change,  classificatory  or  descriptive 
definition,  six  memories  and  arranging  five  or  six  weights. 
Age  XII,  repeating  twenty-six  syllables.  Age  XIII,  all 
tests. 

The  following  tests,  on  the  other  hand,  have  proved  to 
be  too  easy  for  the  age  to  which  they  have  been  assigned. 
Age  VII,  counting  thirteen  pennies.  Age  VIII,  naming 
four  colors.  Age  X,  naming  money.  Age  XII,  three 
rhymes.^ 

In  the  case  of  a  number  of  tests  (including  some  of  the 
above)  the  results  of  different  investigators  are  discrepant. 
The  discrepancies  are  probably  due,  in  part,  to  the  fact 
that  uniform  testing  conditions  have  not  always  been 
followed  by  different  workers,  and  to  the  fact  that  there 
are  national  differences  in  the  strength  of  various  mental 
traits.  Tests  which  are  too  difficult  for  children  of  one 
nationality  may  not  be  too  difficult  for  those  of  another, 
but  just  right,  or  quite  the  reverse. 

In  considering  some  tests  as  too  difficult  and  others  as 
too  easy,  it  is  obvious  that  we  have  posited  a  norm  or 
standard  of  normal  variation  for  each  age-norm.    We  have 

3  For  figures  which  will  substantiate  the  above  conclusions  consult 
the  writer's  Experimental  Studies  of  Mental  Defectives:  A  Critique 
of  the  Binet-Simon  Tests,  and  a  Contribution  to  the  Psychology  of 
Epilepsy,  Warwick  and  York,  Inc.,  1912. 


BINET-SIMON  GRADED  TESTS  205 

proceeded  on  the  assumption  that  age-nox'ms  do  not  pos- 
sess any  scientific  value  unless  a  certain  minimum  percent- 
age of  so-called  normal  children  pass  the  norms  for  their 
chronological  age.  It  is  evident  that  if,  say,  only  25  or 
30  per  cent  of  typical  or  average  children  pass  the  indi- 
vidual tests  or  the  collective  norms  for  their  age  that  the 
norms  are  worthless.  It  is  equally  evident  that  the  require- 
ments are  too  exacting  if  the  standard  of  passing  were 
fixed  at  100  per  cent,  since,  as  already  stated,  mental 
traits,  even  in  normal  children,  will  vary  considerably  from 
the  mode  or  central  tendency.  A  certain  amount  of  varia- 
tion in  the  capacity  of  average  children  of  the  same  age 
must  be  regarded  as  perfectly  normal.  Mental  measure- 
ments, at  their  very  best,  are  variables  and  not  fixed  con- 
stants. Therefore  the  question,  in  the  final  analysis, 
reduces  to  this :  What  shall  we  regard  as  the  maximal  per- 
missible amount  of  variation  in  the  difficulty  of  age-norms 
in  a  measuring  scale  of  intelligence  which  lays  claim  to  the 
character  of  a  scientific  measure.'^  The  extreme  Hmit  may 
be  fixed,  I  believe,  at  25  per  cent.  That  is,  if  75  per  cent 
of  fairly  normal  cliildren  fail  to  pass  the  norms  set  for 
their  age,  the  latter  may  be  regarded  as  too  difficult. 
Certainly,  one  of  the  problems  for  future  investigation  is 
the  determination  of  the  normal  or  maximal  amount  of 
variation  allowable  in  normal  age-norms — the  establish- 
ment of  normal  norms  of  variation. 

Now,  if  we  accept  the  25  per  cent  criterion  of  variation 
as  the  limiting  point,  it  is  evident  that  the  Binet-Simon 
scale  is  far  from  perfect,  even  altogether  aside  from  the 
question  as  to  whether  the  tests  themselves  are  legitimate 
tests  of  intelligence  or  of  intellectual  development.  The 
mere  inequalities  in  the  scale  are,  in  fact,  such  as  to  sug- 
gest that  it  can  be  of  little  if  any  utility.     But  this  con- 


206    MENTAL  HEALTH  OF  SCHOOL  CHILD 

elusion  cannot  be  justified,  I  believe.  Even  with  all  its 
imperfections  the  scale  is  a  fairly  serviceable  objective 
instrument  for  determining  the  relative  mental  station  of, 
or  for  classifying,  homogeneous  groups  of  defective  indi- 
viduals. This  I  have  attempted  to  demonstrate  by  plotting 
efficiency  curves  for  each  of  the  following  individual  traits 
in  epileptics :  the  time  required  to  name  four  colors,  to 
replace  the  blocks  in  a  form  board,  and  to  read  a  given 
selection ;  the  number  of  units  or  memories  reproduced  from 
the  reading  selection,  the  number  of  detached  words  men- 
tioned in  three  minutes,  the  strength  of  the  left  and  right 
hand  grip,  and  the  ataxiagraphic  sway  of  the  body.*  As 
already  stated,  if  the  patients  were  correctly  graded  by  the 
scale  there  should  be  an  increase  in  the  strength  of  each 
mental  trait  with  each  successive  Binet  age.  As  a  matter 
of  fact,  most  of  the  curves  thus  constructed  show  an 
improvement  from  age  to  age.  This  improvement  is  fairly 
smooth  or  regular  except  in  the  color,  dynamometry  and 
ataxiagraphic  tests.  Such  inequalities  as  appear  in  the 
other  graphs  are  probably  often  due  to  the  small  number 
of  subjects  tested  in  certain  ages.  The  strongest  indict- 
ment of  the  scale  furnished  by  these  curves  is  supplied  by 
the  mean  variations.  These  vary  from  15  to  57  per  cent 
for  each  age,  with  an  average  of  nearly  30  per  cent.  While 
a  variation  of  10  or  15  per  cent  is  regarded  as  quite  con- 
siderable in  various  psychological  measurements,  we  need 
to  determine  by  experimental  means,  as  has  been  said, 
what  should  constitute  a  normal  or  maximal  amount  of 
variation  in  normal  age-norms.     In  any  case,  the  maximal 

4  See  my  Experimental  Studies  of  Mental  Defectives :  A  Critique 
of  the  Binet-Simon  Tests  and  a  Contribution  to  the  Psychology  of 
Epilepsy,  Baltimore,  1912,  112f. 


BINET-SIMON  GRADED  TESTS  207 

permissible  variation  would,  as  suggested,  probably  not 
exceed  25  per  cent. 

We  may  conclude,  then,  that  this  objective  measuring 
scale,  however  imperfect,  enables  us  to  grade  and  classify 
defectives  more  accurately  than  can  be  done  by  unaided 
observation.  The  serviceability  of  the  scale  may  be  illus- 
trated from  one  of  my  recent  examinees,  a  male  katatonic 
dementia  precox  case,  age  forty-two,  a  graduate  of  an 
agricultural  college,  now  an  inmate  of  one  of  the  Iowa 
hospitals  for  the  insane.  According  to  the  clinical  and 
ward  records  made  annually  by  the  physician  in  charge, 
the  patient  had  been  gradually  dementing  for  seven  or 
eight  years  and  at  the  time  of  my  visit  was  thought  to  have 
reached  a  very  low  mental  level.  Certain  observations 
made  by  the  superintendent  of  the  institution,  however,  had 
raised  the  presumption  that  tliis  patient  was  in  a  better 
state  of  mental  preservation  than  the  records  indicated. 
He  was  accordingly  put  through  the  Binet-Simon  scale. 
The  result  was  a  surprise.  All  of  the  thirty  highest  tests 
in  the  scale  were  successfully  passed  with  the  exception  of 
two,  one  owing  to  disorientation  in  time  and  one  owing  to 
a  slight  impairment  of  the  weight  sense.  Not  only  so,  the 
responses  were  nearly  always  prompt,  decisive  and  well 
expressed.  Twelve  units  were  reproduced  from  the  reading 
selection,  which  he  read  in  twenty-seven  seconds,  the  prob- 
lem questions  were  answered  in  from  three  to  thirty 
seconds,  the  words  in  the  three  shuffled  sentences  were  cor- 
rectly arranged  in  six,  seven  and  thirty  seconds,  respec- 
tively, and  the  seven  numbers  and  twenty-six  syllables  in 
age  twelve  were  reproduced  instanter.  A  wrong  act  com- 
mitted in  anger  should  be  forgiven  more  quickly  than  one 
not  committed  in  anger  because  'anger  is  a  disease.' 
'Evolution  in  mathematics  occurs  in  connection  with  square 


208    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

and  cube  root  and  permutation,  wliile  revolution  in  society 
is  disorder  leading  to  war.'  'Poverty  is  a  state  of  being 
without  riches,  while  misery  is  the  absence  of  correct 
feeling.'  'Pride  is  a  state  of  mind  in  which  we  show  elation 
over  our  possessions  or  certain  attributes  of  ourselves, 
while  pretension  is  deceit  or  false  claim.' 

Here  is  a  patient  who  had  suffered  from  mental  disease 
for  about  a  dozen  years.  One  hour  of  Binet-Simon  testing 
was  sufficient  to  show  that  he  was  practically  normal 
intellectually  (his  obsessions  excepted).  And  yet  this  fact 
had  not  only  not  been  revealed  by  years  of  unaided  obser- 
vation by  competent  observers,  but  unaided  observation 
had  been  completely  misled.  The  scale,  even  as  at  present 
constituted,  has  undoubted  value  as  a  gauge  for  locating 
mental  status. 

Nevertheless,  it  is  essential  that  we  recognize  the  limita- 
tions and  present  imperfections  of  the  1908  scale.  The 
scale  is  not,  as  some  recent  magazine  and  newspaper 
exploiters  would  have  us  beheve,  a  wonderful  mental 
X-ray  machine  which  will  enable  anyone  to  dissect  the 
mental  and  moral  mechanisms  of  any  normal  or  abnormal 
individual,  a  talisman  which  will  transform  any  ordinary 
observer  into  a  psychic  wizard  and  enable  him  to  infallibly 
measure  mental  status.  Moreover,  it  has  not  yet  been 
adequately  shown  that  the  later  revisions  are  not  also  in 
need  of  extensive  rectification  and  amplification  (see 
Chapter  X). 


CHAPTER  IX 

CURRENT    MISCONCEPTIONS    IN    REGARD    TO 
THE   FUNCTIONS   OF    BINET   TESTING 
AND   OF   A^IATEUR   PSYCHO- 
LOGICAL TESTERS' 

Brevity  is  said  to  be  the  soul  of  wit,  but  it  often  subjects 
one  to  the  charge  of  dogmatism.  Because  of  the  time 
restrictions  imposed  upon  this  paper,  I  fear  that  I  shall 
appear  somewhat  dogmatic  in  the  theses  which  I  shall  lay 
down  in  a  more  or  less  categorical  fashion.  But  the  con- 
clusions arrived  at  have  been  formed  as  a  result  of  the 
psycho-clinical  study  of  a  considerable  variety  of  normal 
and  abnormal  mental  types. 

1.  The  first  popular  misconception  to  which  I  invite 
your  attention  is  the  idea  that  mere  formal,  stereotyped 
psychological  testing  by  any  system  of  tests  whatsoever  is 
all  there  is  to  a  psychological  examination.  The  fact  is 
that  formal  testing  is  only  one  of  the  many  phases  of  a 
mental  examination.  To  be  sure,  it  is  a  fundamentally 
important  phase.  The  development  of  an  objective  con- 
trolled psychological  testing  technique  has  brought  order 
out  of  chaos  in  the  field  of  psycho-educational  diagnosis, 
and  has  done  more  than  anything  else  to  render  the  work 
of  psychological   examination   respectable   and   scientific. 

1  Delivered  at  the  conference  on  the  Binet-Simon  scale,  Fourth 
International  Congress  on  School  Hygiene,  Buffalo,  N.  Y.,  August 
29,  1913.    Printed  here  in  greatly  abbreviated  form. 


210    MENTAL  HEALTH  OF  SCHOOL  CHILD 

But,  while  this  is  so,  it  must  not  be  forgotten  that  there  are 
many  important  clinical  and  developmental  aspects  of 
mental  deviations  which  cannot  adequately  be  revealed  by 
mechanical  testing,  whether  by  the  Binet  or  any  other 
system  of  tests. ^  These  conclusions  have  been  sufficiently 
emphasized  in  Chapter  IV. 

2.  Because  psychological  diagnosis  involves  more  than 
the  ability  to  administer  a  set  of  formal  mental  tests,  it 
is  preposterous  to  suppose  that  one  may  become  a  com- 
petent psycho-educational  examiner  by  taking  a  short 
university  course  on  mental  tests  or  by  taking  a  six-weeks' 
summer  course  in  a  training  school  for  teachers  of  mental 
deficients.  There  is  no  'royal  road'  either  to  psychological 
or  physical  diagnosis.  There  is  no  educational  magic  by 
which  we  can,  in  a  five  or  ten  weeks'  course,  transform  an 
ordinary  observer  into  a  psychic  wizard  and  confer  upon 
him  extraordinary  powers  by  which  he  will  be  able  to 
divine  or  dissect  the  mental  make-up  of  children. 

Let  me  say  here  that  the  evils  which  have  been  creeping 
insidiously  into  clinical  work  in  education  and  psychology 
may  be  partly  attributed  to  the  recent  practice  of  psy- 
chologists, most  of  whom  are  in  no  sense  clinical  men,  of 
offering  courses  on  'mental  and  physical  tests'  to  'all 
comers,'  with  the  implication  that  anyone  who  takes  the 
courses  will  be  qualified  to  diagnose  children  in  the  schools. 
Unfortunately,  those  who  take  such  courses  usually  make 

2  The  following  confirmatory  opinion  is  apropos:  'I  do  not  think 
that  we  can  label  a  child  as  defective  in  mind  by  any  fixed  test,  or 
set  of  tests,  no  matter  how  carefully  thought  out.  As  a  means  of 
exploring  the  workings  of  a  child's  mind  they  are  undoubtedly 
useful,  but  they  cannot  properly  be  regarded  as  standards.  Judged 
by  them  alone,  the  minds  of  many  children  who  are  not  mentally 
defective  will  be  weighed  in  the  balance  and  found  wanting.' — Fred- 
erick Langmead,  M.D.,  School  Hygiene,  London,  1913,  p.  18. 


CURRENT  MISCONCEPTIONS  211 

this  implication,  and  believe  that  somehow  miraculously 
they  have  become  competent  examiners,  even  though  the 
instructor  has  taken  pains  to  emphasize  the  fact  that  no 
one  can  become  a  reliable  educational  diagnostician  with- 
out spending  several  years  in  the  technical  didactic  study 
of  psychology  and  education,  and  in  the  first-hand  clinical 
study  of  different  mental  types.  I  have  deUberately 
limited  eligibility  to  my  psycho-clinical  practicum  to  three 
classes  of  students ;  first,  to  those  who  desire  to  fit  them- 
selves to  become  expert  psycho- educational  examiners  and 
who  are  willing  to  spend  sufficient  time  to  make  themselves 
thoroughly  competent ;  second,  to  those  who  seek  to  develop 
skill  in  the  technique  of  administering  certain  mental  tests, 
in  order  to  quahfy  as  trained  assistants  to  the  expert 
diagnostician ;  and  third,  to  those  who,  seeking  a  practical 
course  in  child  psychology,  desire  to  observe  and  study 
children  in  the  concrete  by  means  of  tests,  for  the  sake  of 
gaining  insight  into  children's  minds  from  a  new  view- 
point, and  not  for  the  sake  of  quaHfying  themselves  as 
psycho-chnical  examiners.  I  would  no  more  regard  the 
two  latter  classes  of  students  as  competent  clinicists  than 
I  would  regard  students  who  had  taken  an  introductory 
experimental  course  in  psychology  as  competent  univer- 
sity professors  of  psychology.  My  demonstration  clinics 
are,  of  course,  open  to  all  who  take  the  didactic  courses. 

Departments  of  psychology  and  education  in  universities 
must  be  held  accountable  for  maintaining  higher  standards 
of  clinical  work  in  psycholog}^  and  education.  They  must 
raise  their  standards  just  as  the  medical  schools  have 
latterly  been  forced  to  adopt  higher  standards  of  work. 
Potential  'quacks'  should  be  kept  out  of  the  field  of 
psycho-educational  diagnosis  no  less  than  they  should  be 
kept  out  of  the  field  of  medicine. 


212    MENTAL  HEALTH  OF  SCHOOL  CHILD 

To  be  sure,  psycho-educational  amateurs,  whether  teach- 
ers, nurses  or  physicians  without  extensive  psychological 
or  educational  training,  may  be  competent  to  administer 
formal  psychological  tests,  provided  they  have  been  suffi- 
ciently trained.  My  experience  indicates  that  it  requires 
two  exercises  per  week  during  a  ten  weeks'  summer  course 
so  to  train  teachers,^  principals,  social  workers  and  college 
graduates  that  they  will  be  able  to  administer  merely  the 
Binet  tests  with  accuracy  and  facility  and  with  confidence 
in  themselves.  But  although  it  is  possible  to  prepare 
measurably  competent  testers  in  short  courses  on  mental 
tests  and  on  the  psychology  and  pedagogy  of  mentally 
exceptional  children,  we  must  not,  therefore,  deceive  our- 
selves with  the  thought  that  we  are  thereby  training 
competent  psycho-educational  diagnosticians .  A  person 
trained  in  short  psychological  and  educational  courses  can 
no  more  be  considered  a  skilled  psychological  and  educa- 
tional clinicist  than  a  nurse  who  has  had  even  three  full 
years  of  training  can  be  considered  a  skilled  physician  or 
surgeon.  The  skilled  psycho-clinicist  would  no  more  think 
of  intrusting  his  diagnoses  to  the  'mental  tester'  than  the 
skilled  physician  or  surgeon  would  intrust  his  diagnoses  to 
the  nurse.  The  role  of  the  Binet  tester  and  the  nurse  is 
precisely  similar:  their  function  is  that  of  the  assistant  to 
the  trained  specialist.     The  medical  nurse  may  serve  as  a 

3  A  recent  critic  avers  that  teachers  can  be  trained  to  become 
perfect  Binet  testers  during  a  five  weeks'  term  by  listening  to  lectures 
and  discussions  on  the  tests,  by  observing  ten  testings  (six  of  these 
by  beginners)  and  by  testing  three  pupils.  Granted.  But  these 
claims  can  scarcely  be  proved  by  having  beginners  test  feeble-minded 
children  who  have  been  tested  again  and  again  by  the  Binet  tests, 
and  who  can,  therefore,  answer  the  questions  in  essentially  the  same 
way  even  though  they  may  be  improperly  asked.  However,  the  essen- 
tial point  is:  Binet  testing  is  one  thing,  diagnosis  is  another. 


CURRENT  MISCONCEPTIONS  213 

trained  examining  assistant,  taking  the  pulse,  tempera- 
ture and  respiration,  assisting  in  the  examinations  and 
administering  treatment.  Likewise,  the  mental  tester  may 
serve  as  a  trained  examining  assistant,  gathering  various 
data,  administering  certain  tests,  and  supervising  treat- 
ment ;  but  neither  the  nurse  nor  the  Binet  nor  any  other 
psychological  tester  is  a  skilled  diagnostician.  The  mental 
diagnostician  must  be  able  not  merely  to  locate  the  mental 
level,  but  also  to  form  a  comprehensive  psycho-clinical 
picture  of  his  case.  In  order  to  prognose  with  measurable 
accuracy,  he  must  be  able  to  trace  symptoms  to  causes, 
and  correctly  differentiate  types.  Mere  psychological 
testing  does  not  indicate  whether  we  are  dealing  with  cases 
of  infantilism  or  simple  imbeciUty,  of  cretinism  or  mon- 
golism, of  moronity  or  backwardness,  of  aprosexia  or 
dullness,  of  inherent  or  merely  apparent  mental  deviation, 
of  stupor  or  amentia,  of  permanent  or  recoverable  impair- 
ment, of  progressive  chorea  or  paralysis,  of  psychotics  or 
neurotics,  of  epilepsy  or  hysteria,  of  idioglossia  or  baby 
talk  or  partial  aphasia,  of  stuttering  or  partial  aphasia 
or  tic  speech.  But  a  diagnosis  involves  the  making  of 
precisely  such  differentiations. 

From  what  I  have  said  it  is  evident  that  psycho-clinical 
diagnosis  and  prognosis  must  be  based  on  the  entire 
symptomatology  of  the  cases  and  not  merely  on  a  few  me- 
chanical tests.  Hence,  let  us  disillusionize  ourselves  of  the 
smug  belief  that  psychological  and  educational  diagnoses 
are  easy  or  trivial  matters.  In  many  cases  they  are  con- 
siderably more  complicated  and  baffling  than  physical  diag- 
noses ;  and  in  any  case  a  skilled  psycho-educational 
diagnostician  will  require  a  preparatory  course  of  training 
not  one  whit  less  technical  or  elaborate  than  the  course 
required  by   the  skilled   oculist,   neurologist   or  psychia- 


214    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

trist.  If  the  science  and  art  of  psycho-educational  diag- 
nosis could  be  mastered  in  a  summer  course,  or  a  couple  of 
short  university  courses,  it  would  be  safe  to  set  it  down  as 
humbug.  Several  teachers  of  more  than  average  training, 
who  have  taken  my  courses  and  who  have  elsewhere 
observed  or  tested  feeble-minded  or  backward  cases  during 
a  six  weeks'  summer  term,  have  remarked  that  they  have 
been  unable  satisfactorily  to  diagnose  all  cases  which  they 
have  studied  even  under  these  very  favorable  conditions, 
and  that  they  regard  it  as  entirely  improbable  that 
teachers,  nurses  or  physicians  who  have  been  trained  to 
give  a  few  formal  psychological  or  educational  tests  have 
thereby  acquired  such  a  profound  understanding  of  the 
children's  mentahty  that  they  are  qualified  to  educationally 
classify  them  correctly  and  to  direct  their  educational 
development. 

The  above  reasons,  among  others,  have  lead  me  to  affirm 
frequently  that  the  department  of  psycho-educational 
diagnosis  in  the  schools  belongs  in  the  educational  division 
rather  than  in  the  department  of  medical  inspection  (see 
Chapter  II).  No  medical  inspector  can  make  a  satis- 
factory educational  diagnosis  and  offer  sane  advice  regard- 
ing the  child's  educational  development  unless  he  is  a 
technically  trained  educationist. 

3.  A  third  set  of  misconceptions  relates  to  the  accu- 
racy of  the  Binet-Simon  scale.  On  the  one  hand,  there 
are  the  exploiters  or  enthusiasts  who  claim  that  the  tests 
are  infallible,  and  certain  serious  and  perfectly  sincere 
students  who,  somewhat  more  modestly,  claim  that  the 
tests  are  astonishingly  accurate.  On  the  other  hand, 
there  are  able  students  who  claim  that  the  tests  are  utterly 
worthless  or  only  of  secondary  consequence.  During 
several  years  I  have  been  making  a  study  of  the  tests  with 


CURRENT  MISCONCEPTIONS  215 

a  considerable  variety  of  cases,  and  have  gradually  formed 
the  conclusion  that  the  tests,  in  spite  of  their  imperfec- 
tions, are  of  considerable  value  to  the  trained  examiner 
(see  Chapter  VIII).  They  provide  a  fairly  impersonal 
and  uniform  method  by  which  to  grade  or  classify,  with  a 
fair  degree  of  accuracy,  institutional  and  school  cases  rela- 
tively to  one  another.  Sometimes  they  enable  us  to  locate 
the  mental  level  of  individual  cases  with  surprising  accu- 
racy. But  it  is  absurd  to  say  that  the  tests  are  'astonish- 
ingly accurate.'  The  construction  of  the  scale  itself  is  by 
no  means  perfect  (as  has  been  shown  in  Chapter  VIII).  It 
is  equally  absurd  to  claim  that  the  tests  provide  a  means 
for  making  an  'infallible'  diagnosis.  On  the  contrary,  as 
already  shown  in  Chapter  IV,  they  may  lead  to  utterly 
worthless,  fallacious,  monstrous  or  pernicious  diagnoses, 
and  they  cannot  be  regarded  as  strictly  rehable,  not  to  say 
infalHble,  shortcuts  for  differentiating  the  backward  from 
the  feeble-minded,  or  the  normal  from  the  supernormal,  or 
the  psychasthenic  from  the  asthenic,  or  the  Freudian 
psycho-neurotic  with  retardation  from  the  mentally  defi- 
cient. Valuable  as  they  are,  they  are  not  a  diagnostic 
automaton  which  will  serve  as  a  satisfactory  substitute  for 
an  expert  examiner. 

4.  And  finally:  the  impression  prevails  that  adequate 
and  reliable  clinical  norms  can  be  established  by  group 
tests  or  by  the  random  testing  of  limited  numbers  of 
children.    This  misconception  is  discussed  in  Chapter  X. 


CHAPTER  X 

RE-AVERMENTS     RESPECTING    PSYCHO- 
CLINICAL  NORMS  AND  SCALES  OF 
DEVELOPMENT' 

Recent  discussions  seem  to  call  for  a  reemphasis  of 
certain  conclusions  at  which  I  had  previously  arrived. 

1.  An  expert  experimental,  ediLcational  or  genetic 
psychologist  is  not,  in  any  legitimate  use  of  the  word,  a 
skilled  clinical  psychologist.'  The  former  has  no  more 
right  to  regard  himself  as  an  expert  clinical  psychologist 
than  the  professional  anatomist  or  physiologist  has  to 
consider  himself  a  medico-clinical  examiner.  The  skilled 
psycho-clinicist  will  require  just  as  prolonged  and 
thorough  a  technical  preparation  as  the  skilled  medico- 
clinicist.^  Just  as  the  preparation  of  the  physician  neces- 
sitates more  than  a  thorough  grounding  in  anatomy,  phy- 
siology and  embryology,  so  the  preparation  of  the  clinical 
psychologist  requires  more  than  an  expert  knowledge  of 
general,  experimental,  educational,  genetic  or  abnormal 
psychology  or  of  child  study.*  He  should  have  in  addition 
a  thorough  training  in  psycho-clinical  procedure,  which 
should  include  not  only  work  in  a  laboratory  clinic  but  an 

1  Reprinted,  with  various  additions,  from  The  Psychological  Clinic, 
1913,  pp.  89-96. 

2  Science,  1913;  Journal  of  Educational  Psychology,  1912,  p.  234. 

3  Journal  of  Educational  Psychology,  1912,  p.  224f ;  Science,  1913. 

4  Journal  of  Educational  Psychology,  1911,  p.  207f. 


PSYCHO-CLINICAL  NORMS  217 

intemeship — a  'hospital  year,'  so  to  speak, — spent  in  first- 
hand study  of  backward,  feeble-minded,  epileptic,  psycho- 
pathic and  disciplinary  cases.  These  cases  must  be 
juvenile  subjects  if  the  examiner  intends  to  work  with  chil- 
dren. He  must  have  also  a  thorough  training  in  educa- 
tional therapeutics.  By  this  I  include  primarily  not  the 
so-called  psycho-therapeutics  of  the  skilled  psychiatrist  or 
psychopathologist — suggestion,  psycho-analysis,  reeduca- 
tion— but  particularly  the  differential,  corrective  peda- 
gogics of  the  educational  expert  on  mentally  deviating 
children.  There  is,  however,  no  general  scheme  of  correc- 
tive pedagogics.  The  methods  will  have  to  be  differentiated 
to  meet  the  needs  indicated  by  a  diagnosis  of  each  case.  It 
will  be  as  different  for  the  feeble-minded  and  for  the 
stutterer  as  it  is  for  the  deaf  and  for  the  blind.  Finally, 
the  clinical  psychologist  must  have  some  knowledge,  didac- 
tic and  clinical,  of  physical,  orthopedic  and  pediatric 
defects,  of  neurotic  and  psychotic  symptomatology,  and  of 
personal,  family  and  heredity  case-taking. 

It  is  evident  that  there  is  no  modern  specialist  who  is 
equipped  with  all  these  elements  of  knowledge  except  the 
properly  trained  clinical  psychologist.  The  general 
practitioner,  pediatrician,  orthopedist,  neurologist,  psy- 
chiatrist, educational,  experimental,  genetic  or  abnormal 
psychologist  is  lacking  in  some  of  the  essentials  which  the 
expert  psycho-clinicist  must  possess.  The  ordinary  special- 
class  teacher  (or  school  nurse)  is,  of  course,  not  to  be  con- 
sidered for  a  moment  as  a  trained  psycho-clinicist.^     To 

5  Experimental  Studies  of  Mental  Defectives,  1:110;  Journal  of 
Educational  Psychology,  1912,  p.  224.  Medical  Record,  September  20, 
1913.  A  similar  view  is  evidently  entertained  by  Bruner,  Addresses 
and  Proceedings  of  the  National  Educational  Association,  1912,  p. 
lllOf 


218    MENTAL  HEALTH  OF  SCHOOL  CHILD 

be  sure,  well-trained  classroom  teachers  can  learn  to 
administer  a  few  tests,  and  may  thereby  be  able  to  group 
some  children  with  approximate  accuracy  into  retarded, 
normal  and  accelerated  classes,  just  as  an  intelligent 
layman  may  be  able  to  classify,  with  some  accuracy,  people 
into  sickly  and  healthy  groups.  But  surely  the  skilled 
physician  attempts  to  do  more  than  roughly  classify  his 
cases.  In  the  measure  in  which  he  is  competent,  he  makes 
a  differential  diagnosis  of  each  case  and  adapts  the  treat- 
ment to  the  diagnosis.  The  problem  of  the  competent 
psycho-clinicist  is  precisely  the  same :  he  must  attempt  not 
only  to  measure  the  amount  of  mental  deviation  but  to  give 
a  differential  diagnosis  of  each  case.  The  teacher  or  nurse 
may,  indeed,  be  of  considerable  service  as  an  assistant  to 
the  psycho-clinicist — provided,  of  course,  that  she  pos- 
sesses the  requisite  tact  and  the  necessary  technical  train- 
ing. To  her  (or  him)  may  be  entrusted  a  considerable 
portion  of  the  formal,  mechanical  testing,  and  the  collec- 
tion of  the  data  for  the  case  histories.  But  her  relation 
to  the  clinical  psychologist  is  much  the  same  as  the  relation 
which  the  trained  nurse  sustains  to  the  skilled  surgeon. 
The  psycho-clinicist  would  no  more  think  of  entrusting 
the  final  diagnosis  of  a  mentally  abnormal  child  to  the 
teacher  or  nurse,  than  the  physician  would  permit  a  nurse 
to  make  a  differential  diagnosis  of  a  physically  diseased 
person.  A  teacher  or  nurse  or  physician,  whose  psycho- 
logical training  is  limited  to  elementary  courses  and  to 
giving  the  Binet  or  other  mental  tests,  has  no  more  right 
to  the  title  of  clinical  'psycliologist,  than  a  nurse  who  is 
trained  to  take  the  temperature,  pulse  or  any  other  medi- 
cal readings  has  a  right  to  call  herself  a  physician. 

It   may    always   be   necessary   to   utilize   more   or    less 
unskilled,  or  only  partially  skilled,  workers  in  the  mental 


PSYCHO-CLINICAL  NORMS  219 

testing  of  deviating  children,  because  we  shall  probably 
not  be  able  for  a  long  time  in  the  future  to  secure  a  suffi- 
cient number  of  adequately  trained  specialists  to  examine 
the  millions  of  pedagogically  deviating  children  which  clog 
the  wheels  of  our  educational  machine.  But  this  crude 
type  of  work — routine  testing  by  amateurs — will  probably 
not  enable  us  to  select  mentally  retarded  children  with 
markedly  greater  precision  than  can  now  be  done  by  the 
ordinary  classroom  standards  for  determining  pedagogical 
retardation.  Nor  will  it  give  us  any  markedly  superior 
insight  into  the  peculiarities  of  the  mental  defects  of  the 
children.  Extensive  use  of  the  tests  on  various  types  of 
children  (normal,  backward,  feeble-minded,  epileptic,  in- 
sane, precocious)  has  convinced  me  that  many  diagnoses 
by  teachers,  physicians  or  nurses  based  purely  upon  the 
Binet  tests  will  be  very  misleading,  often  humorously 
absurd,  and  at  times  pernicious.  The  diagnoses  wliich  I 
make  after  an  exhaustive  study  of  all  the  available  facts 
are  quite  at  variance  with  the  Binet  rating  in  a  consider- 
able percentage  of  cases.  I  am  free  to  confess,  however, 
that  I  have  found  the  Binet  scheme  of  more  value  than 
have  the  psychologists  in  the  Chicago  schools  (judging 
by  personal  reports  made  to  me  by  Dr.  Bruner). 

It  should  be  remembered  that  mental  testing  is  only 
one  phase  of  mental  diagnosis  ;  the  determination  of  mental 
status  does  not  automatically  include  the  determination  of 
the  causative  factors.  'The  function  of  the  Binet-Simon, 
or  any  other  graded  scale  of  intelligence,  is  to  give  us  a 
preliminary,  and  not  a  final  survey  or  rating  of  the  indi- 
vidual.' The  testing  is  'merely  a  point  of  departure  for 
further  diagnosis.'®    Grade  teachers  or  nurses  are  'unfitted 

6  Experimental  Studies  of  Mental  Defectives,  109 


220    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

for  the  two  highest  functions  of  the  psycho-clinicist.  First, 
they  are  incapable  of  giving  a  satisfactory  diagnosis  (the 
chief  consideration  in  any  examination)  of  individual 
cases ;  and  secondly,  they  are  unable  to  conduct  research — 
to  prosecute  productive  and  constructive  research.'^  And 
I  want  to  repeat  with  all  possible  emphasis  that  the  real 
function  of  the  amateur— the  examining'  teacher  or  nurse 
or  the  physician  unskilled  in  psychology — in  the  schools  is 
not  that  of  the  clinical  psychologist  or  the  expert  diagnos- 
tician, but  that  of  the  laboratory  assistant  to  the  skilled 
diagnostician,  who,  so  far  as  mental  cases  are  concerned, 
must  be  the  specially  trained  clinical  psychologist. 

That  there  are  only  a  few  clinical  psychologists  who 
have  an  adequate  conception  of,  and  training  for,  this 
type  of  work  it  is  almost  needless  to  say — though  unfor- 
tunately there  are  many  teachers  and  psychologists  who 
quite  delude  themselves  (largely  because  of  the  prevalent 
fluid  standards  of  what  constitutes  a  skilled  clinical  exami- 
nation) into  the  belief  that  they  are  prepared  to  function 
as  competent  consulting  psycho-clinicists.  It  is,  however, 
no  matter  for  wonder  that  there  are  only  a  few  competent 
clinical  psychologists — persons  who  are  qualified  to  act 
as  professional  or  trustworthy  consultants  rather  than  men 
who,  themselves  lacking  in  clinical  experience,  may  be  able 
to  write  learnedly  on  what  the  clinical  psychologist  should 
do.  For  clinical  psychology  is  just  in  its  infancy.  But 
I  believe  it  is  safe  to  predict  that  the  type  of  training 
insisted  on  in  this  book  will  in  future  be  demanded  of  the 
mental  examiner  of  deviating  children. 

2.  Norms  of  mental  functioning  established  by  experi- 
mental  or  educational  psychologists   by  group   tests   on 

7  Journal  of  Educational  Psychology,  1912,  p.  225. 


PSYCHO-CLINICAL  NORMS  221 

squads  of  children  may  have  little  practical  value  as 
clinical  tests.^     There  are  various  reasons  why  this  is  so. 

First — group  tests  require  written  responses.  But  the 
clinical  psychologist  must  reduce  written  responses  to  a 
merely  nominal  amount,  partly  because  children  differ  in 
the  rate  or  skill  of  writing  without  evincing  a  correspond- 
ing difference  in  intelligence ;  partly  because  many  abnor- 
mal children  suffer  from  special  motor  defects  of  the  hand, 
so  that  they  cannot  do  themselves  justice  in  graphic  tests; 
and  partly  because  written  responses  require  too  much 
time.  A  comprehensive  psycho-clinical  examination  is  a 
time-consuming  ordeal,  hence  there  is  no  time  to  waste  on 
the  mechanics  of  writing.  There  are,  of  course,  many 
valuable  tests  wliich  can  only  be  done  in  writing,  and 
these  should  be  given  in  as  brief  a  form  as  may  be  feasible. 

Second — many  of  the  best  single  group  tests  carried 
out  by  the  experimental  and  educational  psychologists 
cannot  be  given  in  less  than  from  three  to  thirty  minutes. 
It  is  quite  practicable  for  the  educational  psychologist  to 
give  lengthy  tests  because  usually  during  any  one  sitting 
he  attempts  to  measure  only  a  limited  number  of  traits. 
But  the  psycho-clinicist,  in  order  to  get  a  comprehensive 
picture  of  his  case,  must  test  a  very  considerable  number 
of  functions.  Hence  the  time  of  each  test  must  necessarily 
be  reduced  to  an  'irreducible  minimum.' 

Third — experiments  show  that  children  do  better  when 
tested  in  groups  than  when  tested  singly.^  For  this  reason 
group  norms  may  not  be  serviceable  as  clinical  norms. 
Merely  on  a  priori  grounds,  since  the  conditions  of  testing 
are  different,  we  should  always  feel  a  certain  amount  of 
skepticism  about  the  accuracy  of  clinical  norms  which  have 

8  Alienist  and  Neurologist,  May,  1912. 

9  See  BuRNHAM,  Science,  1912,  p.  761f. 


222    MENTAL  HEALTH  OF  SCHOOL  CHILD 

been  derived  from  group  results.  As  a  matter  of  fact, 
nearly  all  norms  now  in  practical  use,  whether  mental  or 
anthropometric,  have  been  secured  by  individual  and  not 
by  group  testing. 

It  is  just  because  our  clinical  norms  must  be  based  on 
individual  and  not  on  group  testing  that  the  task  of 
securing  them  is  herculean.  It  is  this  fact  that  I  had  in 
mind  in  previously  emphasizing  that  the  establishment  of 
extensive  and  reliable  clinical  norms  requires  a  large  staff 
of  workers  and  an  ample  subsidy. ^°  The  problem  would 
be  comparatively  simple  if  group-norms  could  be  used  with 
assurance  for  clinical  work :  it  takes  no  more  time  to  test 
forty  pupils  at  once  in  a  group  than  to  test  one  pupil 
alone.  It  is  worth  repeating,  therefore,  that  it  is  probably 
not  to  the  group  results  of  the  educational  and  experi- 
mental psychologists  that  we  must  look  for  our  norms  but 
to  the  clinical  data  of  examiners  of  individual  cases.  At 
any  rate,  some  one  should  make  a  comparative  study  to 
determine  whether  there  is  any  difference  between  norms 
estabUshed  by  group  tests  and  norms  for  the  same  tests 
established  clinically. 

3.  So  far  as  concerns  the  probing  of  the  efficiency  of 
mental  functions  by  testing,  the  most  serviceable  clinical 
examining  technique  consists  in  the  graded  scales  of  intel- 
lectual, motor  and  socio-industrial  {possibly  also  emo- 
tional) development.^^  The  high  value  which  Thomdike^^ 
ascribes  to  the  correlation  formula  probably  is  justified  so 
far  as  concerns  the  diagnosis  of  the  school  system  or  of  a 

10  Journal  of  Educational  Psychology,  1911,  p.  204;  Alienist  and 
Neurologist,  May,  1912;  Experimental  Studies  of  Mental  Defectives, 
1912,  p.  56ff. 

11  Pedagogical  Seminary,  1911,  p.  74ff. 

12  Science,  1913,  p.  133. 


PSYCHO-CLINICAL  NORMS  223 

number  of  individuals  of  the  same  ages  when  tested  in 
groups.  But  the  most  valuable  contribution  made  thus 
far  to  the  technique  of  clinical  diagnosis — and  funda- 
mentally diagnosis  means  precisely  clinical  diagnosis — 
does  not  come  from  the  correlation  formula.  If  there  is 
any  professional  psycho-clinicist  whose  constant  reliance 
in  the  diagnosis  of  individual  cases  is  the  Pearson  formula, 
I  do  not  happen  to  know  him.  No  one  has  yet  selected 
tests  for  developmental  scales  on  the  basis  of  correlation 
coefficients,  although  it  is  probable  that  in  the  selection  of 
tests  for  such  scales  preference  should  be  given  to  tests 
which  have  been  shown  by  group  experiments  to  possess  a 
high  degree  of  correlation.  Certainly  the  most  important 
type  of  'educational  diagnosis'  done  today,  from  the  point 
of  view  of  the  practical  good  accomplished  for  the  children, 
is  clinical  diagnosis ;  and  the  value  of  the  technique  of 
individual  diagnosis  would  be  little  impaired  if  the  corre- 
lation formula  were  non-existent. 

4.  The  position  I  have  taken  in  favor  of  the  continued 
use  of  the  1908  Binet  scale  until  an  extensive  mass  of 
chnical  data  is  available  for  a  thoroughly  scientific  revi- 
sion of  the  scale^^  seems  to  me  to  be  justified  by  the  develop- 
ments. The  relocations  of  the  tests  do  not  always  accord 
with  the  author's  own  findings,  or  with  the  findings  of 
other  investigators,  and  numerous  contradictions  and  dis- 
crepancies have  not  been  satisfactorily  eliminated.  The 
detailed  analysis  of  the  numerous  revisions  wliich  have 
appeared  in  less  than  a  year  is  here  out  of  place.  But  it 
is  well  to  remind  the  reader  that  Binet  and  Simon's  own 

13  The  Psychological  Clinic,  Vol.  V,  No.  7,  December,  1911,  p.  218; 
Journal  of  Educational  Psychology,  1912,  p.  224f;  Alienist  and 
Neurologist,  May,  1912;  Experimental  Studies  of  Mental  Defectives, 
1912,  pp.  55,  117. 


224    MENTAL  HEALTH  OF  SCHOOL  CHLLD 

1911  revision,  so  far  as  I  can  gather,  is  largely  theoretical. 
Evidently  it  was  made  to  meet  some  of  the  criticisms  lodged 
against  the  1908  scale:  viz.,  inequality  in  the  number  of 
tests  for  each  age ;  the  presence  of  scholastic  or  training 
tests ;  incorrect  placing  of  tests,  etc.  It  was  not  based,  as 
it  should  have  been  to  meet  any  justifiable  scientific  de- 
mands, on  the  retesting  of  large  masses  of  normal  children. 
Moreover,  some  of  the  changes  introduced  into  the  scale 
fly  directly  in  the  face  of  experimental  warrant.  Thus 
the  date  test  is  placed  in  Age  VIII  although  the  authors 
maintain  that  naming  dates  are  'facts  that  boys  of  nine 
are  just  able  to  retain'  (Town's  translation).  'AH  the 
children  at  eleven  years'  succeed  in  composing  single  sen- 
tences containing  three  designated  words ;  children  of 
eleven  succeed  in  giving  sixty  words  in  three  minutes ;  'at 
eleven  the  majority'  succeed  in  giving  abstract  definitions; 
and  yet,  notwithstanding  these  findings,  these  tests  are 
placed  in  Age  XII.  Here  we  have  the  absurd  procedure 
of  placing  tests  in  an  age  in  which  they  do  not  belong,  in 
the  interests  of  a  theoretical  reconstruction,  and  of  leaving 
an  important  age  vacant.  It  would  be  interesting  to  know 
the  evidence  on  which  the  seven-digit  and  rhyme  tests  were 
placed  in  Age  XV.  As  a  matter  of  fact,  the  XV-year 
norms,  not  to  mention  any  others  in  this  revision  as  well 
as  in  certain  other  revisions,  are  practically  worthless. 
Moreover,  it  is  more  important  to  have  supplied  reliable 
tests  for  Ages  XI,  XIII  and  XIV,  than  for  Age  XV  and 
for  adulthood. 

Of  the  other  revisions,  particularly  the  American,  which 
have  appeared  in  rapid  succession,  it  may  be  said  that  in  no 
case  are  they  based  upon  the  performances  of  selected 
normal  children  (however,  no  one  has  yet  demonstrated 
whether  selected  or  unselected  cases  should  be  used)  ;  in 


PSYCHO-CLINICAL  NORMS  225 

one  case  a  revision  has  been  made  on  the  performances  of 
feeble-minded  persons ;  in  no  case  has  an  extensive  number 
of  cases  been  tested  in  every  age  that  has  been  revised 
(the  one  possible  exception  is  Goddard's  survey;  this  is 
entirely  commendable  from  the  point  of  view  of  the  number 
of  children  tested,  but  it  is  vulnerable,  I  believe,  because  of 
the  narrow-range  scheme  of  testing  employed)  ;  in  no  case 
have  the  revisions  been  based  on  the  testing  of  children 
who  have  just  passed  their  birthdays  (some  six-year-olds 
have  been  six  years  and  one  month,  others  six  years  and 
eleven  months)  ;  in  no  case  has  the  uide-range  method  of 
testing  been  used,  which  I  have  found  essential  for  pur- 
poses of  testing  out  the  accuracy  of  the  placing  of  the 
tests  ;^*  in  some  cases  revisions  have  been  made  in  ages  in 
which  only  fifteen  or  twenty  children  have  been  tested,  while 
in  other  instances  age-norms  have  been  revised  or  supplied 
although  not  a  single  child  has  been  tested  in  those  ages. 
This  manner  of  constructing  measuring  scales  may  be 
fascinating  as  an  intellectual  diversion,  and  the  scales  may 
indeed  be  suggestive  and  possess  certain  theoretical  inter- 
ests and  values ;  but  I  must  submit  that  the  serviceability 
of  scales  thus  constructed  for  the  purpose  of  the  practical 
reliable  diagnosis  of  the  cases  which  daily  come  to  the 
clinic  is  questionable.  Superficial  work  like  this  is  mislead- 
ing and  tends  to  arouse  contempt  for  the  slipshod  stan- 
dards of  scientific  work  obtaining  in  this  field  of  applied 
psychology.  Worst  of  all,  these  scales,  because  of  the 
claims  made  as  to  their  reliability,  are  appropriated  and 
used  by  large  numbers  of  uncritical  Binet  testers  who  are 
neither  psychologists  nor  scientists,  and  thereby  pupils  are 
judged  or  stigmatized  on  the  basis  of  unproved  assump- 

14  Experimental  Studies  of  Mental  Defectives,  pp.  21,  28,  55. 


226    MENTAL  HEALTH  OF  SCHOOL  CHILD 

tions.  Instead  of  glutting  the  market  with  measuring 
scales  whose  accuracy  has  not  been  sufficiently  established 
by  extensive  testing  to  render  them  practically  serviceable, 
it  would  be  better  if  the  investigator  devoted  his  time  to 
thorouglily  testing  out,  standardizing  and  establishing 
age-norms  for  single  tests.  It  is  this  type  of  extensive, 
detailed  'draft-horse'  work  which  is  now  most  needed. 

5.  The  improvement  of  mental  measuring  scales 
involves  not  merely  the  standardization  of  the  administra- 
tive procedure,  nor  yet  merely  the  establishment  of  reliable 
age-norms  for  the  tests  already  incorporated  in  existing 
scales;^^  but  it  requires  the  addition  of  new  tests  in  the 
various  age-steps ;^^  the  establishment  of  age-norms  for 
half-years  for  younger  children ;^^  the  establishment  of 
various  age-standards  throughout  the  scale  for  the  sam£ 
type  of  test ;  the  establishment  of  normal  norms  of  varia- 
tion in  addition  to  normal  norms  of  performance;^^  and 
the  elaboration  not  only  of  intelligence  scales,  but  of 
scales,  separate  or  combined,  of  motor,  socio-industrial  and 
possibly  emotional  development,  as  well  as  tests,  graded  or 
otherwise,  of  the  characteristic  types  of  mental  disorgani- 
zation   which    obtain    in    various    disequilibrations    and 

15  Pedagogical  Seminary,  1911,  p.  70ff;  Experimental  Studies  of 
Mental  Defectives,  p.  56 f. 

16  Experimental  Studies  of  Mental  Defectives,  p.  56;  Alienist  and 
Neurologist,  May,  1912. 

17  Journal  of  Educational  Psychology,  1911,  p.  206.  The  scheme 
there  proposed  should  read  as  follows:  'The  six-year  group  will 
include  children  from  five  years  ten  months  (beginning  of  tenth 
month)  to  six  years  three  months  (end  of  third  month),  while  the 
six  and  one-half  year  group  will  include  children  from  six  years  four 
months  (beginning  of  fourth  month)  to  six  years  nine  months  (end 
of  ninth  month).' 

18  Alienist  and  Neurologist,  May,  1912;  Experimental  Studies  of 
Mental  Defectives,  pp.  42,  104f. 


PSYCHO-CLINICAL  NORMS  227 

psychoses — tests  of  orientation,  paranoidal  or  delusional 
trends,  memory  for  remote  and  recent  happenings,  etc.,  so 
that  graded  and  standardized  scales  may  better  serve  the 
purpose  of  differential  diagnosis. 

The  need  for  tests  of  conative  capacity  and  emotional 
development  is  evident.  A  child's  mentality  includes  more 
than  the  cognitive  function :  he  is  a  being  who  feels  as  well 
as  knows  and  his  life-success  often  depends  on  how  he  feels 
and  does.  The  most  satisfactory  single  measure  of  a 
child's  mentality  is  undoubtedly  the  test  of  his  intellectual 
development.  This  furnishes  the  best  preliminary  working 
basis  for  diagnosing  his  mental  age.  But  to  fix  a  child's 
mental  age  fully,  we  must  also  have  especially  graded 
series  of  tests  of  motor-industrial  performances. 

The  number  of  tests  in  each  age  should  be  increased  to, 
say,  ten  rather  than  decreased  to  five,  as  has  been  done  in 
the  recent  revisions.  It  is  hazardous  to  attempt  to  use 
the  scale  to  mentally  diagnose  defective  individuals  on  the 
basis  of  a  few  deviations  or  abnormalities.  Moreover, 
since  individuals  of  the  same  age  and  training  vary  con- 
siderably in  different  traits,  the  scale  must  be  so  compre- 
hensive that  it  will  survey  a  maximal  number  of  funda- 
mental functions — so  many  that  we  shall  be  measurably 
certain  of  striking  a  fair  average.  Several  of  the  tests 
eliminated  in  the  1911  revision  have  given  such  valuable 
insight  into  the  mental  condition  of  epileptic  and  insane 
defectives  that  it  would  be  a  misfortune  to  drop  them 
simply  because  they  are  'schooly,'  or  because  the  capacities 
tested  are  influenced  by  training.  Indeed,  nature  and 
nurture  are  mutually  interacting  and  reciprocating 
factors  in  the  developmental  process,  whence  it  is  idle  to 
attempt  to  sharply  separate  tests  into  those  which  measure 
nature's  dower  and  those  which  measure  the  contribution 


228    MENTAL  HEALTH  OF  SCHOOL  CHILD 

made  by  the  environment.  The  environmental  factors 
begin  to  influence  the  individual  at  the  very  portal  of  life, 
and  practically  no  child  of  school  age  in  this  country  suc- 
ceeds in  evading  the  formal  educative  influences  of  the 
school. 

The  standardization  of  the  methodological  technique  is 
a  fundamental  prerequisite  of  all  scientific  work.  Tests 
cannot  be  given  or  repeated  under  uniform  and  controlled 
conditions,  particularly  not  by  amateurs,  unless  the  pro- 
cedure is  fully  set  forth,  both  as  to  what  is  permissible  and 
as  to  what  is  expressly  forbidden.  Moreover,  a  standard- 
ized procedure  for  each  test  should  be  followed.  I  have 
found  experimenters  who  read  for  the  child  the  reading 
selection  for  ages  eight  and  nine,  instead  of  requiring  the 
child  to  do  the  reading.  Some  tell  the  child  in  advance  that 
he  is  expected  to  reproduce  what  he  reads  or  what  is  read 
to  him,  while  others  say  nothing  about  this.  Some  give 
the  tests  as  group,  instead  of  clinical  tests,  thereby  both 
changing  the  conditions  and  omitting  certain  tests  in  each 
age-level  which  cannot  be  given  group-wise.  Discrepan- 
cies in  results  inevitably  arise  from  such  diversities  of  pro- 
cedure. Fortunately  attempts  to  standardize  the 
procedure  have  recently  been  made  by  several  workers. 

Since  emphasizing  the  advisability  of  testing  identical 
traits  at  various  age-levels  by  the  same  form  of  test,  and 
thus  determining  the  status  of  specific  individual  traits  in 
diff^erent  individuals  in  terms  of  normal  age  standards,^^ 
this  need  has  been  recognized  by  other  writers. ^°     As  I 

19  Pedagogical  Seminary,  1911,  p.  76f;  Experimental  Studies  of 
Mental  Defectives,  pp.  8f,  56,  109;  Journal  of  Educational  Psychology, 
1912,  pp.  224f ;  Epilepsia,  1912,  p.  368. 

20  Seashore,  Journal  of  Educational  Psychology,  1912,  p.  50;  and 
Pyxe,  same  Journal,  1912,  p.  95. 


PSYCHO-CLINICAL  NORMS  229 

have  stated  before:"^  'We  know  little  at  present  that  is 
scientifically  accurate  regarding  the  degree  or  character 
of  the  physical  and  mental  arrest  of  our  repeaters.  We 
therefore  stand  in  need  of  comprehensive  serial  graded 
tests  of  intelligence,  so  that  we  may  determine  not  only  the 
intellectual  age  of  deviating  children,  but  the  nature  of 
the  mental  functions  most  seriously  affected.'  A  series  of 
consecutive  tests,  each  differing  somewhat  from  the  others, 
which  I  have  used  with  various  groups  of  children  and 
which  can  be  given  once  annually  for  a  period  of  six  years, 
are  now  available. 

The  greatest  present  obstacle  to  genuine  progress  in 
psycho-clinical  work  is  the  lack  of  reliable  normal  mental 
age-norms  for  the  fundamental  mental  capacities.  Until 
these  are  supplied  the  work  of  routine  inspection  and  con- 
sultation will  be  more  or  less  blind  or  guideless.  There- 
fore, in  the  present  stage  of  the  science,  the  first  concern 
of  departments  of  cHnical  psychology  in  schools,  univer- 
sities, psychopathic  institutes  or  institutions  for  defectives 
should  be  the  establishment  of  reliable  psychical  (and 
anthropometric)  normal  age-norms  for  individual  traits. 
Tliis,  I  judge,  was  essentially  the  view  of  Smedley,  who 
devoted  his  energies,  while  he  was  connected  with  the 
laboratory  of  the  Chicago  schools,  toward  the  estabhshment 
of  developmental  norms,  particularly  of  an  anthropometric 
nature.  No  one  has  yet  made  any  systematic  attempt  on 
an  adequate  scale  to  give  us  normal  mental  development 
norms,  Binet  possibly  excepted.  Nor  is  it  probable  that 
reliable  age-norms,  whether  psychological,  pedagogical 
or  anthropometric,  will  ever  be  supplied,  unless  the  work 
is  undertaken,  intensively  and  systematically,  b}^  a  large 

21  Pedagogical  Seminary,  1911,  p.  82. 


230    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

research  foundation,  or  unless  the  work  is  properly  par- 
celed out  among  the  various  psychologists  in  universities, 
normal  schools,  public  schools,  psychiatric  institutes  and 
institutions  for  defectives.  For  we  shall  not  be  able  to 
test  existing  scales  satisfactorily  except  by  wide-range 
testing  (Chapter  IV),  nor  shall  we  be  able  to  establish 
thoroughly  reliable  norms  except  by  testing  multitudes  of 
normal  children,^^  at  the  very  minimum  one  hundred  boys 
and  one  hundred  girls  at  each  age  by  years  and  also  by 
half-years  in  the  earher  ages.  It  would  be  better  to  set 
the  number  at  five  hundred  or  a  thousand  for  each  age. 
That  would  be  a  gigantic  undertaking,  however,  requiring 
the  concentrated  attack  of  a  large  corps  of  trained 
workers,  but  the  ultimate  results  which  this  research  would 
yield  toward  the  better  understanding  of  children  would 
well  repay  the  toil  and  expense  required. 

22  Pedagogical  Seminary,  1911,  p.  81;  Journal  of  Educational  Psy- 
chology, 1912,  p.  225f ;  Alienist  and  Neurologist,  May,  1912;  Epilepsia, 
1912,  p.  376;  Experimental  Studies  of  Mental  Defectives,  pp.  21,  28, 
55. 


CHAPTER  XI 
INDIVIDUAL  AND  GROUP  EFFICIENCY' 

For  ages,  men  waged  wars  on  purely  fortuitous  or  hap- 
hazard principles.  Not  until  Bismarck  and  Von  Moltke 
instituted,  parallel  with  the  hne,  a  military  staff  organi- 
zation composed  of  scientific  experts,  was  warfare  reduced 
to  a  science  and  conducted  in  accordance  with  the  scientific 
principles  of  efficiency.  The  military  supremacy  attained 
by  the  German  army,  after  it  had  been  organized  in 
accordance  with  staff  efficiency  principles,  has  lately  been 
duplicated  by  the  Japanese  government  through  a  similar 
organization  of  its  mihtary  forces.  The  modem  science  of 
national  efficiency  in  its  broadest  aspects  may  thus  be  said 
to  owe  its  inception  to  the  military  application  of  efficiency 
principles  in  the  empire-building  campaign  of  Germany. 

For  four  or  five  thousand  years  men  have  been  building 
houses  out  of  bricks.  Successive  generations  of  masons 
have  probably  laid  the  bricks  in  much  the  same  uneconomi- 
cal fashion.  The  thought  that  bricklaying  could  be  done 
in  strict  accordance  with  a  scientific  standard  of  efficiency 
seems  not  to  have  dawned  upon  the  world  until  an  efficiency 
engineer  of  our  own  day,  Frank  Gilbreth,  demonstrated 
by  means  of  a  simple  experiment  in  psychological  observa- 
tion and  chronometry,  that  thirteen  of  the  eighteen  cus- 
tomary movements  in  bricklaying  were  entirely  superfluous 

1  Reprinted,  with  additions,  from  the  Psychological  Bulletin,  1913, 
pp.  390-397. 


232    MENTAL  HEALTH  OF  SCHOOL  CHILD 

and  that,  supplied  with  standardized  conditions  and  stan- 
dardized operations,  the  output  of  the  average  bricklayer 
could  be  increased  from  120  to  360  bricks  per  hour,  with- 
out any  material  increase  in  the  amount  of  physical  exer- 
tion or  fatigue.  The  modern  application  of  scientific 
efficiency  principles  to  the  details  of  'shop  management' — 
to  the  utilization  of  labor,  materials,  equipment,  the  details 
of  operation  and  distribution — had  its  origin  in  the  time 
and  motion  studies  of  Frederick  W.  Taylor  in  the  Midvale 
Iron  Works,  about  thirty  years  ago,  by  means  of  which 
the  maximal  limit  of  efficient  performance  under  normal 
and  wholesome  conditions  was  scientifically  determined. 
This  forward  movement  in  human  engineering  deserves  to 
be  ranked  with  the  introduction  more  than  one  hundred 
years  ago  of  uncarnate  power  in  the  place  of  carnate 
forces,  as  the  instrument  by  means  of  which  the  world's 
labor  was  to  be  accomplished.  For  (although  mechanical 
power  is  decidedly  cheaper  than  man  power — from  '135  to 
1,350  times  cheaper')  the  scientific  studies  of  occupational 
habits  and  task  schedules  have  not  only  multiplied  the 
producing  capacity  of  human  muscular  power  three-  or 
fourfold,  but  they  have  led  to  the  introduction  of  labor 
systems  which  have  transformed  devitalized,  mechanical 
toilers  into  organizers,  directors,  administrators  and  con- 
structive forces. 

Begun  as  a  scientific  attempt  at  economic  empire- 
building  and  profitable  industrial  organization,  the  effi- 
ciency propaganda  has  latterly  become  crystallized  into 
a  system  of  efficient  psycho-technics,  and  has  grown  into 
a  national  philosophy,  a  philosophy  of  conservation  and 
efficiency,  single  in  its  controlling  aim  (the  elimination  of 
waste  due  to  human  inefficiency),  and  all-inclusive  in  its 
scope.      The   philosophy   is   applicable   alike  to   men   and 


EFFICIENCY  233 

materials,  methods  and  management,  labor  and  capital, 
employer  and  employee,  line  and  staff,  rank  and  file, 
lettered  and  unlettered,  producer  and  consumer,  service 
and  equipment,  processes  and  plants,  natural  resources 
and  manufactured  products,  factory  and  church,  school 
and  shop,  charity  and  business,  nation  and  state,  city  and 
corporation,  individual  and  community,  unit  and  group. 

The  results  of  the  present-day  widespread  interest  in 
the  gospel  of  efficiency,  human  and  material,  are  seen  on 
every  hand:  in  the  incorporation  of  efficiency  planks  into 
the  national  party  platforms  (conservation  of  natural  and 
human  resources)  ;  in  the  establishment  of  national  conser- 
vation bureaus  (the  Children's  Bureau)  ;  in  the  organiza- 
tion of  municipal  research  bureaus  (the  Bureau  of  Muni- 
cipal Research  of  New  York  City,  Chicago  Bureau  of 
Municipal  Efficiency,  the  Pittsburgh  Social  Survey  and 
Morals  Efficiency  Commission,  etc.)  ;  in  the  establishment 
of  departments  of  heredity  or  psycho-clinical  research  in 
institutions  for  various  kinds  of  mental  defectives,  juvenile 
courts,  public  schools  and  universities ;  in  the  organization 
in  the  public  schools  of  departments  of  health  supervision 
and  child  hygiene  (unfortunately  still  largely  restricted 
to  limited  systems  of  'medical  inspection')  ;  in  the  organiza- 
tion of  staffs  of  consulting  specialists  or  efficiency  engineers 
in  industrial  and  commercial  plants ;  in  the  founding  of 
efficiency  societies  (thus  the  American  Society  for  Pro- 
moting Efl^ciency,  April,  1912,  the  National  Committee 
for  Mental  Hygiene,  1912,  the  American  Association  for 
the  Study  and  Prevention  of  Infant  Mortality,  the  Ameri- 
can School  Hygiene  Association,  etc.)  ;  in  the  launching 
of  efficiency  periodicals  (thus  Human  Engineering,  Cleve- 
land, 1912 ;  The  Child,  Chicago,  1912),  and  in  the  creation 
of  a  rapidly  growing  literature,  dedicated  to  the  objective. 


234    MENTAL  HEALTH  OF  SCHOOL  CHILD 

impersonal,  scientific  study  of  the  factors  or  conditions 
which  make  or  mar  human  efficiency,  whether  in  the  indi- 
vidual or  in  the  group. 

In  the  following  pages  it  is  my  purpose  to  review  briefly 
the  efficiency  literature  which  has  appeared  during  the  last 
two  years,  and  which  admits  of  summary  under  the  heads 
which  follow  : 

1.  The  conservation  and  increase  of  vocational  {indus- 
trial-commercial) efficiency,  by  means  of  scientific  shop  or 
business  management. 

In  two  lucidly  written  and  aptly  illustrated  volumes, 
Emerson  has  presented  the  ablest  exposition  extant  of  the 
philosophy  of  efficient  industrial  management  (9),  together 
with  a  codification  of  the  practical  scientific  principles 
involved  (10).  He  recognizes  that  efficient  shop  manage- 
ment— which  depends  on  the  establishment  of  scientific 
analytical  motion  and  time  studies,  of  time  equivalents  for 
every  operation  or  task,  and  the  adoption  of  a  standard 
service  or  labor  equivalent  for  a  given  wage — cannot  be 
instituted  without  a  staff"  of  consulting  experts,  consisting 
not  merely  of  efficiency  engineers  and  wage  specialists,  but 
also  of  'character  analysts,'  psychologists,  hygienists, 
physiologists,  bacteriologists  and  economists.  While  abso- 
lute standards  for  chemical,  physical  and  electrical  pro- 
cesses can  readily  be  set  and  enforced,  human  beings  must 
be  rated,  classified  and  treated  as  sentient,  moral  beings. 
Properly  to  administer  men  on  efficiency  principles  requires 
the  expert  services  of  the  psychologist,  physiologist,  phy- 
sician and  humanitarian.  Indeed,  Emerson  avers  that,  so 
far  from  being  a  purely  material  engineering  problem,  the 
highest  staff'  standards  are  psychological.  'It  is  psy- 
chology, not  soil  or  climate,  that  enables  a  man  to  raise 
five  times  as  many  potatoes  per  acre  as  the  average  of  his 


EFFICIENCY  235 

own  state'  (9,  p.  107).  Moreover,  the  science  of  industrial 
efficiency  is  an  idealistic  philosophy,  and  not  merely  a  cold, 
brutal,  calculating  scheme  for  oppressing  labor — a  fact 
which  has  been  emphasized  by  Brandeis  (3),  who  argues 
that  there  is  no  inherent  incompatibility  between  the  claims 
of  scientific  management  and  the  rights  of  organized  labor. 
Scientific  management  means  the  'square  deal'  for  the 
wage-worker :  shorter  hours,  without  'speeding  up' ;  more 
regular  employment  and  greater  security  of  tenure;  pro- 
portionately higher  financial  returns ;  instruction  for  the 
inefficient;  and  a  heightened  feeling  of  self-respect  and 
interest  in  the  work. 

That  the  problem  is  in  part  both  psychological  and 
pedagogical  is  likewise  emphasized  by  Gantt  (the  author 
of  the  'bonus  system'  of  compensation,  which  provides 
extra  pay  for  work  satisfactorily  done  in  a  specified  time : 
piece  work  for  the  skilled  and  day  work  for  the  unskilled). 
He  (11)  recognizes  the  need  of  a  factory  pedagogue,  who 
must  be  a  keen  psycho-analyst  as  well  as  an  efficient 
teacher.  His  duties  will  consist  in  instructing  the  work- 
men, in  training  them  to  form  efficient  vocational  habits, 
and  to  acquire  habits  of  industry  and  willing  cooperation. 
The  policy  of  the  past  was  to  drive  or  force  the  wage 
worker :  in  the  future  it  must  be  to  teach  and  lead.  The 
whip  must  be  replaced  by  stimuli  derived  from  skilled 
instruction,  merited  promotion  and  a  deserved  bonus. 

That  the  new  science  of  industrial  efficiency  cannot 
justify  itself  solely  by  its  economic  fruits,  but  must  also 
be  judged  by  its  ultimate  physiological  and  social  effects 
upon  the  workers,  is  emphasized  by  Goldmark  (12a),  in 
an  able  and  comprehensive  digest  of  the  literature  bearing 
on  'Fatigue  and  Efficiency'  in  industry.  (The  best  psy- 
chological researches,  unfortunately,  receive  no  mention  in 


236    MENTAL  HEALTH  OF  SCHOOL  CHILD 

this  voluminous  compilation.)  Owing  to  the  strong  ten- 
dency to  exploit  the  workers  wliich  will  exist  under  any 
kind  of  management,  the  interests  of  racial  efficiency  need 
to  be  protected  by  adequate  labor  legislation.  Such  legis- 
lation must,  in  the  first  instance,  be  based  on  scientific 
studies  of  fatigue.  Scientific  shop  management  will  have 
to  conform  to  the  physiological  laws  (and  psychological, 
forsooth)  underlying  the  industrial  life. 

The  psychological  and  pedagogical  principles  which 
may  be  utilized  to  increase  business  efficiency  receive  their 
most  explicit  formulation  by  the  psychologist.  Scott 
(19)  considers  that  human  efficiency  is  not  solely  dependent 
on  inherent  capacity,  but  on  a  number  of  mental  factors 
which  it  is  possible  intelligently  to  utilize  by  becoming 
familiar  with  the  principles  of  business  and  educational 
psychology.  Scott  discusses  a  number  of  psychological 
principles  which  can  be  practically  applied  to  increase 
business  efficiency,  such  as  imitation,  competition,  loyalty, 
concentration,  wages,  pleasure,  habit-formation  and 
relaxation.^ 

2.  The  conservation  and  increase  of  the  efficiency  of 
eminent  talent,  by  the  scientific,  impersonal,  objective 
study  and  control  of  the  conditioning  factors  of  scientific, 
literary  and  artistic  eminence,  fame  or  genius. 

After  a  lapse  of  seven  years,  Cattell  (5)  has  repeated  his 
statistical  group  study  of  the  most  eminent  American  men 
of  science.  He  has  undertaken  an  analysis  of  the  changes 
which  have  taken  place  during  these  years,  in  the  relative 
rank,  and  In  the  sectional,  state,  city.  Institutional,  pro- 
fessional,  sex   and   age  distribution   of   scientific   workers 

2  For  a  recent  statement  of  the  relation  of  psychology  to  industrial 
and  commercial  efficiency  see  Miinsterberg,  Hugo,  Psychology  and 
Industrial  Efficiency,  Boston,  1913. 


EFFICIENCY  237 

throughout  the  country.  Among  the  more  important 
furthering  environmental  factors  are  geographical  loca- 
tion or  institutional  affiliation,  and  professional  position 
(career).  Massachusetts  and  Connecticut  continue  to 
maintain  their  scientific  preeminence,  while  three-fourths 
of  the  leading  scientists  are  in  the  teaching  profession — 
only  three  medical  men  not  teaching  in  medical  schools  find 
positions  in  the  distribution. 

Cattell's  explanation  of  the  fact  that  only  eighteen  of 
our  1,000  leading  scientists  are  women  as  due  to  an 
'innate  sexual  disqualification,'  is  rejected  by  Hayes  (13) 
and  Talbot  (22),  who  find  the  cause  in  woman's  social  and 
educational  inequalities  and  handicaps. 

Woodworth  (32)  finds  six  or  seven  factors  responsible 
for  the  fact  that  the  average  American  standard  of 
scientific  productivity  is  below  the  European  level,  of 
which  the  most  important  is  our  rapid  national,  industrial, 
economic  and  educational  expansion.  The  fields  of  indus- 
trial, economic  and  educational  promotion,  organization 
and  administration  offer  higher  financial  and  social 
rewards,  and  have  thereby  attracted  our  best  minds. 

But  the  fact  that  Massachusetts  and  Connecticut  have 
produced  far  more  eminent  men  in  proportion  to  the  gen- 
eral population  than  Virginia,  North  Carolina  or  South 
Carolina  cannot  be  accounted  for,  according  to  Johnson 
(15),  on  Woods'  hypothesis  of  the  dominance  of  heredity 
over  environment.  It  is  due,  as  shown  by  the  financial 
school  budgets  of  these  states,  to  the  greater  expenditure 
of  money  for  educational  purposes  in  New  England  than 
in  the  Southern  States. 

On  the  other  hand,  the  Whethams  (29),  from  an  his- 
toriometric  study  by  the  space  method  of  one-fifth  of  con- 
secutive   names    in    the    British   Dictionary    of    National 


238    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Biography,  reach  the  conclusion  that  able  parents  have 
able  children,  provided  'like-to-like'  matings  occur,  as  is 
found  to  be  the  case  among  the  English  administrative 
and  peerage  classes.  The  comparative  inferiority  of  the 
progeny  of  artistic,  literary  or  scientific  men  is  due  to  the 
fact  that  these  classes  of  men  form  chance  alliances :  they 
do  not  mate  with  their  likes.  The  'Hke-to-like'  matings 
thus  subserve  an  important  evolutionary  function :  they 
create  a  super-class  in  the  general  population. 

In  this  connection  note  may  be  made  of  Stern's  recom- 
mendation (20)  for  the  conservation  of  incipient  talent, 
that  special-talent  classes  and  a  special  pedagogy  should 
be  provided  for  supernormal  children;  and  of  Kiernan's 
contention  (17)  that  the  genius  is  a  child  potentially 
developed,  biologically  and  psychologically,  that  he  must 
be  provided  with  a  favorable  environment,  particularly 
during  the  psycho-biological  stress  periods,  and  that  his 
potentialities  must  be  aided  by  all-round  development  and 
not  by  one-sided  stimulation,  which  will  tend  to  upset  the 
instable  bio-psychological  mechanism. 

One  sympathizes  with  the  facts,  which  are  emphasized 
and  deplored  in  current  discussions  of  the  super-cliild  or 
super-adult,  that  we  lack  at  present  any  satisfactory 
standard  of  genius  (the  Whethams,  29),  that  misconcep- 
tions of  precocity  are  widespread  (O'Shea,  18),  and  that 
the  necessity  has  not  always  been  recognized  of  clearly 
distinguishing  between  merit  and  fame  in  historiometric 
discussions  (Browne,  4).  Woods'  claim  (31)  that  his- 
toriometry  (the  objective  statistical  treatment  and  relative 
grading  of  the  fame  of  historical  characters)  can  be 
reduced  to  an  exact  science  is  denied  by  Browne  (4),  be- 
cause this  would-be  science  does  not  possess  any  historio- 
metric functions  of  constant  value.     This  is  particularly 


EFFICIENCY  239 

true  of  the  adjective  method  (the  ratio  of  the  number  of 
adjectives  of  praise  to  dispraise),  which  does  not  give  a 
constant  differential  value  to  adjectives  of  different  quanti- 
tative importance.  Browne  considers  the  adjective  method 
inferior  to  the  space  and  reference-frequency  methods. 

3.  The  conservation  and  increase  of  racial  efficiency, 
through  eugenical  matings,  and  the  elimination  of  the  unfit 
by  sterilization  or  segregation. 

Among  the  significant  studies  of  the  hereditary  factors 
involved  in  dependency,  defectiveness  and  delinquency  are 
the  family  history  investigations  of  Davenport  (7)  and 
Goddard  (12).  Davenport  voices  his  disapproval  in  no 
uncertain  terms  ('Oh,  fie  on  legislators  who  spend  thou- 
sands of  dollars  on  drastic  action  and  refuse  a  dollar  for 
an  inquiry  as  to  the  desirability  of  such  action!')  of  the 
legislative  efforts  to  eliminate  the  unfit  by  the  enactment 
of  compulsory  steriHzation  or  anti-procreation  laws.  He 
favors  the  milder  remedy  suggested  by  segregation. 

Notice  should  be  taken  of  an  attempt  to  standardize  the 
methods  of  collecting,  charting  and  analyzing  hereditary 
data  (8). 

4.  The  conservation  and  increase  of  the  mental  effi- 
ciency of  individuals,  by  means  of  the  removal  of  physical 
defects  (orthophrenics  through  orthosomatics) ,^  or  by  the 

3  I  would  suggest  the  use  of  the  word  orthophrenic  to  designate  any 
process  or  regimen  by  means  of  which  deviate  mentality  may  be  made 
to  function  aright;  the  word  orthosomatic  to  designate  any  process  or 
regimen  by  means  of  which  any  malfunctioning  bodily  organ  may  be 
made  to  work  normally;  and  the  word  orthogenic  as  the  generic  term 
to  apply  to  any  orthophrenic  or  orthosomatic  processes  of  restoring 
deviate  human  nature  to  normal  functioning.  All  these  processes 
are  essentially  and  specifically  pedagogico-  or  medico-corrective. 
Eflfectually  to  apply  them  presupposes  the  development  of  a  number 
of  highly  technical  orthogenic  sciences. 


240    MENTAL  HEALTH  OF  SCHOOL  CHILD 

administration  of  proper  pharmaco-  or  dietetico-dynamic 
agents. 

Wallin  has  measured  by  serial  psychological  tests  given 
throughout  a  school  year  the  euthenical  effects  of  oral 
treatment  and  prophylaxis  on  the  working  efficiency  of 
school  children  (see  Chapter  XIII).  The  contention  is 
made  'that  the  desirability  of  establishing  dental  clinics  in 
the  public  schools  for  free  inspection  and  treatment  should 
present  itself  to  the  taxpayer  as  a  simple  business,  if  not 
a  humanitarian,  proposition — the  paying  of  proper  divi- 
dends on  the  capital  invested  in  the  schools,'  the  elimina- 
tion of  preventable  waste. 

The  elaborate  series  of  psychological  measurements  of 
Hollingworth  (14)  of  the  influence  of  caffeine  on  various 
mental  and  motor  processes  and  on  the  sleep  and  general 
health  of  a  control  squad  of  sixteen  male  and  female  adults 
will  serve  as  a  model  for  similar  scientific  investigations  in 
the  future  of  the  somato-euphoric  and  psycho-orthogenic 
effects  of  the  use  of  various  drugs,  foods,  dietaries, 
etc.  His  results  indicate  that  mental  efficiency  may  be 
heightened,  without  reactionary  after-effects,  by  the 
administration  of  judicious  doses  of  caffeine  in  its  pure 
form. 

Closely  related  is  5.  The  conservation  and  increase  of 
the  working  efficienct/  of  the  sclwol  population,  of  normal 
or  abnormal  pupils,  in  elementary,  higher,  special,  rural, 
urban  or  state  institutions,  by  the  scientific  study  and 
control  of  the  processes  and  agencies  which  directly  or 
indirectly  minister  to  psycho-pedagogical  proficiency. 

Perhaps  we  may  agree  with  the  eugenist  that  permanent 
racial  improvement  will  come  only  by  improving  the  inborn 
qualities  of  men  (considered  under  3,  above).  At  the 
same  time,  we  are  obliged  to  deal  with  conditions  as  we 


EFFICIENCY  241 

find  them ;  after  the  human  misfits  have  been  bom,  we  must 
bring  them  to  maximal  efficiency  by  improving  the  environ- 
mental factors.  The  most  important  euthenical  agencies 
are  the  schools,  and  the  training  or  corrective  institutions. 
And  it  is  gratifying  to  observe  that  in  no  field  of  modern 
enterprise  is  the  efficiency  problem  receiving  greater  scien- 
tific study  than  in  the  realm  of  education.  Here  the  major 
studies  have  been  concerned  with  the  attempt  to  determine 
more  accurately  than  was  formerly  the  case  the  current 
rate  of  progress  through  the  grades  (thus  Blan,  2;  Keyes, 
16;  Strayer,  21);  with  the  introduction  of  effective 
schemes  of  varying  the  rate  of  progress  through  the 
grades,  so  that  the  needs  of  the  individual  pupil  may  be 
properly  conserved  (for  example,  the  Mannheim  system  of 
grade  organization.  Van  Sickle,  25)  ;  with  the  attempt  to 
differentiate  curricula,  so  as  to  render  them  sufficiently 
varied  to  meet  the  needs  of  all  types  of  exceptional  children 
(witness  the  recent  organization  of  special  classes,  occupa- 
tional courses,  elementary  industrial,  trade  and  continua- 
tion schools)  ;  with  the  effort  to  establish  by  diagnostic, 
psychological  tests,  developmental  age-scales  of  personal, 
social,  industrial,  motor  and  intellectual  traits  for  re- 
tarded, average  and  accelerated  pupils,  so  that  pedagogi- 
cal or  vocational  tasks  may  be  fitly  adjusted  to  the  level  of 
functioning  of  each  child  (thus  Wallin's  plan  for  gauging 
the  efficiencies  of  a  colony  of  epileptics,  27)  ;  with  the 
task  of  establishing  pedagogical  efficiency  scores,  criteria 
or  scales,  by  which  to  make  an  impersonal,  objective  deter- 
mination of  a  child's  proficiency  in  various  branches  of  the 
curriculum,  such  as  English  composition  (Thomdike,  23), 
handwriting  (Thorndike,  24;  Ayres,  1)  and  the  funda- 
mental operations  in  arithmetic  (Courtis,  6)  ;  witli  the 
effort   to    determine    the    functional    efficiencv    of   various 


242    MENTAL  HEALTH  OF  SCHOOL  CHILD 

methods  of  teaching,  such  as  the  incidental  or  drill  method 
of  teaching  spelling  (Wallin,  28,  who  fails  to  substantiate 
the  claims  of  Rice  and  Cornman,  and  who  shows  by  tests 
that  spelling  efficiency  can  be  increased  by  the  utiUzation 
of  a  psychologically  justifiable  drill  technique)  ;  and  with 
the  attempt  to  determine  the  best  age  at  which  to  enter 
children  in  the  schools  (Winch,  30,  who  finds  that  there  is 
no  intellectual  advantage  in  entering  children  at  three 
rather  than  at  five  in  English  schools). 

This  survey  of  the  literature  on  human  efficiency — 
necessarily  all  too  brief  relatively  to  the  importance  of  the 
subject — should  leave  a  threefold  impression  in  the  mind 
of  the  reader:  first,  that  the  problem  of  conserving  and 
increasing  the  efficiency  of  the  race  is  many-sided,  present- 
ing many  varied  and  complex  phases ;  second,  that  the 
problem  is  soluble  only  through  the  development  and  appli- 
cation of  a  distinct  scientific  technique,  sufficiently  varied 
and  specialized  to  fit  any  phase  of  the  problem ;  and,  third, 
that  the  problem  is  too  large  to  be  solved  by  any  one  type 
or  class  of  existing  investigators,  but  that  it  requires  the 
development  of  a  new  type  of  scientific  investigators, 
namely,  a  cooperative  corps  of  'efficiency  experts'  in 
physiology,  psychology,  education,  hygiene,  medicine,  an- 
thropology, sociology,  philanthropy,  economy,  chemistry, 
engineering  and  jurisprudence. 

References 

1.  Ayres,  L.  p.  a  Scale  for  Measuring  the  Quality  of 
Handwriting  of  School  Children.  Department  of  Child 
Hygiene,  Russell  Sage  Foundation,  New  York,  1912. 

2.  Blan,  L.  B.  a  Special  Study  of  the  Incidence  of  Retar- 
dation. Teachers  College,  Columbia  University,  New 
York,  1911,  pp.  111. 


EFFICIENCY  243 

3.  Brandeis,  Louis  D.  Organized  Labor  and  EflSciency. 
The  Survey,  1911,  26:  148-151. 

4.  Browne,  C.  A.  The  Comparative  Value  of  Methods  of 
Estimating  Fame.     Science,  1911,  33:770-773. 

5.  Cattell,  J.  McK.  A  Further  Statistical  Study  of 
American  Men  of  Science.  In  American  Men  of  Science, 
New  York,  2d  ed.,  1910,  564-596. 

6.  CouRTiSj  S.  A.  Standard  Scores  in  Arithmetic.  The 
Elementary  School  Teacher,  1911,  12:  127-137. 

7.  Davenport,  C.  B.  Heredity  in  Relation  to  Eugenics. 
Henry  Holt  &  Co.,  New  York,  1911,  pp.  298. 

8.  Davenport,  C.  B.,  et  al.  The  Study  of  Human  Hered- 
ity. Eugenics  Record  Office,  Cold  Spring  Harbor, 
Bulletin  No.  2,  pp.  17. 

9.  Emerson,  H.  Efficiency  as  a  Basis  for  Operation  and 
Wages.  The  Engineering  Magazine,  New  York,  1912, 
pp.  254. 

10.  Emerson,  H.  The  Twelve  Principles  of  Efficiency.  The 
Engineering  Magazine,  New  York,  1912,  pp.  423. 

11.  Gantt,  H.  L.  Work,  Wages  and  Profits.  The  Engi- 
neering Magazine,  New  York,  1911,  pp.  194. 

12.  GoDDARD,  H.  H.  Heredity  of  Feeble-Mindedness. 
American  Breeders  Magazine,  1910,  1:165-178. 

12a.  GoLDMARK,  Josephine.  Fatigue  and  Efficiency,  a  Study 
in  Industry.  Charities  Publication  Committee,  New 
York,  1912.  Part  I,  pp.  288.  Part  II,  pp.  565.  (Briefs 
in  defense  of  women's  labor  laws  by  Louis  D.  Brandeis 
and  Josephine  Goldmark.) 

13.  Hayes,  Ellen.  Women  and  Scientific  Research. 
Science,  1910,  32:864-866. 

14.  Hollingworth,  H.  L.  The  Influence  of  Caffeine  on 
Mental  and  Motor  Efficiency.  Archives  of  Psychology, 
New  York,  1912,  22:  166. 

15.  Johnson,  G.  H.  Dr.  Woods'  Application  of  the  His- 
toriometric  Method.     Science,  1911,  33:773-775. 


244.    MENTAL  HEALTH  OF  SCHOOL  CHILD 

16.  Keyes,  C.  H.  Progress  through  the  Grades  of  City 
Schools.  Teachers  College^  Columbia  University,  New 
York,  1911,  pp.  79. 

17.  KiERNANj  J.  G.  Is  Genius  a  Sport,  a  Neurosis,  or  a 
Child  Potentially  Developed  ?  The  Alienist  and  Neurolo- 
gist, serial  articles  from  May,  1907,  to  February,  1912. 

18.  O'Shea,  M,  V.  Popular  Misconceptions  Concerning 
Precocity  in  Children.     Science,  1911,  34:  666-674. 

19.  Scott,  W.  D.  Increasing  Human  Efficiency  in  Business. 
The  Macmillan  Co.,  New  York,  1912,  pp.  339. 

20.  Stern,  W.  The  Supernormal  Child.  Journal  of  Edu- 
cational Psychology,  1911,  2:143-148;  181-190. 

21.  Strayer,  G.  D.  Age  and  Grade  Census  of  Schools  and 
Colleges.  Bulletin  No.  451,  United  States  Bureau  of 
Education,  Washington,  1911,  pp.  144. 

22.  Talbot,  Marion.  Women  and  Scientific  Research. 
Science,  1910,  32:  866. 

23.  Thorndike,  E.  L.  A  Scale  of  Merit  in  English  Writing 
by  Young  People.  Journal  of  Educational  Psychology, 
1911,  2:  361-368. 

24.  Thorndike,  E.  L.  Handwriting.  Teachers  College 
Record,  New  York,  1910,  pp.  93. 

25.  Van  Sickle,  J.,  et  al.  Provision  for  Exceptional  Chil- 
dren in  Public  Schools.  Bulletin  461,  United  States 
Bureau  of  Education,  Washington,  1911,  pp.  92. 

26.  Wallin,  J.  E.  W.  Experimental  Oral  Euthenics. 
Dental  Cosmos,  1912,  54:404-413;  545-566.  Also, 
Experimental  Oral  Orthogenics.  Journal  of  Philosophy, 
Psychology,  and  Scientific  Methods,  1912,  9:290-298. 

27.  Wallin,  J.  E.  W.  Human  Efficiency,  a  Plan  for  the 
Observational,  Clinical  and  Experimental  Study  of  the 
Personal,  Social,  Industrial,  School  and  Intellectual  Effi- 
ciencies of  Normal  and  Abnormal  Individuals.  Ped. 
Sem.,  1911,18:  74-84.  See  also  Eight  Months  of  Psycho- 
Clinical  Research  at  the  New  Jersey  State  Village  for 


EFFICIENCY  245 

Epileptics,  with  Some  Results  from  the  Binet-Simon 
Testing.  Transactions  of  the  National  Association  for 
the  Study  of  Epilepsy  and  the  Care  and  Treatment  of 
Epileptics,  1912,  8:29-43.  (Reprinted  in  Epilepsia, 
1912.) 

28.  Wallin,  J.  E.  W.  Spelling  Efficiency,  in  Relation  to 
Age,  Grade  and  Sex,  and  the  Question  of  Transfer. 
Warwick  and  York,  Baltimore,  1911,  pp.  91.  Also,  How 
to  Increase  Spelling  Efficiency.  Atlantic  Educational 
Journal,  1912,  7:225-226. 

29.  Whetham,  W.  C.  D.  &  C.  D.  Eminence  and  Heredity. 
The  Nineteenth  Century,  1911,  69:  818-832. 

30.  Winch,  W.  H.  When  Should  a  Child  Begin  School.? 
Warwick  &  York,  Baltimore,  1911,  pp.  98. 

31.  Woods,  F.  A.  Historiometry  as  an  Exact  Science. 
Science,  1911,  33:568-574. 

32.  WooDWORTH,  R.  S.  On  Factors  Contributing  to  a  Low 
Scientific  Productivity  in  America.  Science,  1911,  33: 
374-379. 


CHAPTER  XII 

THE  EUTHENICAL  AND  EUGENICAL  ASPECTS 
OF  INFANT  AND  CHILD  ORTHOGENESIS' 

The  mental  and  physical  health  of  children  is  a  national 
asset  which  the  state  is  under  obligation  to  preserve  and 
develop,  for  the  indefinite  improvement  of  humanity  and 
the  cause  of  the  young  child  are  inseparably  interwoven. 
The  problem  of  infant  mortality,  therefore,  cannot  be 
viewed  apart  from  the  larger  problem  of  race  conser- 
vation ;  and  in  the  final  analysis  the  problem  of  race  con- 
servation involves  not  only  race  preservation  but  a  two- 
fold process  of  human  orthogenesis :  first,  a  process  of 
physical  orthogenesis,  or  orthosomatics,  by  which  I  refer 
to  any  process  through  which  malfunctioning  physical 
organs  may  be  made  to  function  aright,  or  by  means  of 
which  healthy  organs  may  be  continued  at  normal  func- 
tioning, so  that  the  physical  organism  may  develop  to  its 
maximal  potential;  and  secondly,  a  process  of  mental 
orthogenesis,  or  orthophrenics,  by  which  I  refer  to  any 
process,  mental  or  physical,  of  righting  any  malfunction- 
ing mental  power,  so  that  the  mind  may  realize  its  highest 
developmental  possibilities.  On  such  a  theory,  the  imme- 
diate purpose  of  a  constructive  community  program — 
and  only  a  community  program  will  prove  genuinely  effi- 

1  Read  before  the  American  Association  for  Study  and  Preven- 
tion of  Infant  Mortality  at  the  annual  meeting  in  Cleveland,  Ohio, 
October  3,  1912.  Reprinted  from  Transactions  of  the  Association, 
1912,  3: 173-194,  and  from  The  Psychological  Clinic,  1912,  pp.  155-173. 


CHILD  ORTHOGENESIS  247 

cacious — of  race  conservation  or  human  orthogenesis,  may 
be  stated  as  irreducibly  threefold : 

First,  salvation;  i.e.,  the  salvation  of  every  born  babe,  fit 
or  unfit,  from  a  premature  grave.  Perhaps  it  were  better 
to  follow  the  example  of  the  Greeks,  a  nation  of  ancient 
eugenists,  and  allow  the  unfit,  provided  they  could  be 
infallibly  diagnosed,  to  perish  by  exposing  them  to  death 
perils.  But  this  expedient  can  be  dismissed  at  once, 
because  the  very  thought  is  abhorrent  to  the  twentieth 
century  mind. 

Secondly,  improvement;  i.e.,  the  maximal  uplift  or  up- 
building, bodily  and  mental,  of  every  surviving  babe, 
whether  fit  or  unfit,  so  that  it  may  reach  its  maximal 
potential  of  social  efficiency.  The  duty  to  preserve  the 
unfit  babe,  once  it  is  born,  implies  the  duty  to  provide  it 
with  that  nurture  and  protection  wliich  will  bring  it  to 
its  highest  estate. 

Thirdly,  elimination;  i.e.,  the  eradication  of  the  social 
misfits,  not  by  the  impossible  expedient  of  enforced  select- 
ive euthanasia,  chloroforming  or  infanticide,  but  by  the 
reduction  of  the  birth  rate  of  the  unfit  stock,  and  the 
increase  of  the  birth  rate  of  normal  healthy  babies. 

If  the  immediate  or  ultimate  aim  of  the  infant  mortality 
crusade  cannot  be  reduced  beyond  the  above  triple  mini- 
mum, it  is  evident  that  a  scheme  of  constructive  planning 
must  include  remedial,  corrective  and  preventive  work,  by 
the  control  of  environmental  and  hereditary  factors. 
While  much  of  the  conflict  between  the  groups  of  environ- 
mental and  hereditary  infant  welfare  workers  is  due  to 
the  paucity  of  demonstrated  facts  in  this  field,  which 
enables  one  group  to  attribute  all,  or  nearly  all,  the  blame 
for  infant  mortality,  or  for  racial  depopulation  and  de- 
generacy, to  environment,  while  the  other  group  just  as 


248    MENTAL  HEALTH  OF  SCHOOL  CHILD 

confidently  holds  heredity  responsible;^  yet  it  is  probably 
true  that  the  greater  part  of  the  controversy  is  due  to 
one-sided  views  as  to  the  basal  aims  to  be  realized,  and 
accordingly  the  methods  to  be  employed  in  an  infant 
mortality  crusade.  On  the  one  hand,  there  are  some 
euthenists  who  limit  the  legitimate  scope  of  the  work  to 
the  saving  of  life  from  premature  extinction,  and  who 
underrate,  if  they  do  not  entirely  neglect,  a  program  of 
subsequent  diagnosis,  care  and  training ;  while  on  the  other 
hand,  there  are  those  who  admit  that  a  follow-up  program 
of  orthogenic  reconstruction  undeniably  possesses  value 
for  the  individual,  but  insist  that  it  has  no  beneficent 
influence  on  race  improvement,  that  permanent  race  im- 
provement can  result  only  from  eugenical  breeding,  and 
that  environment  is  of  minor  importance.  The  student  of 
orthogenics,  however,  regards  it  as  impossible  of  practical 
achievement  and  fatal  to  the  realization  of  the  highest 
orthogenic  results  in  the  work  of  race  reconstruction,  to 
attempt  to  divorce  the  above  aims,  to  neglect  one  at  the 
expense  of  either  of  the  other  two,  and  to  create  a  wide 
gulf  between  the  euthenical  and  eugenical  factors  of 
control. 

In  the  space  that  remains  I  purpose  to  present  a  brief 
statement  of  the  points  of  view,  claims,  evidence  and  the 
measures  advocated  by  the  two  schools  of  infant  conser- 
vationist workers,  and  to  offer  a  few  suggestions  for  a 
fairly  comprehensive  program  of  euthenical  and  eugenical 
work. 

2  Few  of  the  factors  productive  of  infant  mortality  have  been 
studied  under  thoroughly  satisfactory  conditions  of  analytical  con- 
trol; hence  the  value  of  many  of  the  statistical  findings  is  question- 
able. Yet  these  discrepant  findings  are  constantly  used  in  support  of 
the  most  divergent  claims.  There  is  great  need  of  genuine  scientific 
research  in  this  field.    Too  much  of  it  has  been  quite  pseudo-scientific. 


CHILD  ORTHOGENESIS  249 

EUTHENICS 

The  euthenist  claims  that  the  major  percentage  of 
infant  deaths  are  due  to  a  maladjusted  environment,  or 
to  detrimental  factors  which  are  under  environmental 
control.     He  tells  us : 

That  the  vast  majority  (some  say  90  per  cent)  of  babies  are 
well  born; 

That  adverse  environmental  influences  are  not  more  destruc- 
tive of  the  biologically  inapt  than  the  biologically  apt  infant; 

That  since  the  hereditary  factors  exert  a  minor  influence 
during  early  life,  the  eugenically  fit  will  succumb  during 
infancy  quite  as  readily  as  the  eugenically  unfit; 

That  the  high  infant  mortality  rate  is  in  part  due  to  the  cir- 
cumstance that  infancy  is  the  period  of  most  rapid  development, 
and  the  powers  of  immunity  are  weakened  during  the  critical 
periods  of  maximal  development; 

That  most  infants  die  of  preventable  digestive  disorders 
caused  by  bad  feeding,  bad  food,  food  infected  particularly  by 
the  house  fly,  or  by  injurious  drugs  or  beverages,  and  of  pre- 
ventable respiratory  diseases,  caused  by  bad  air  and  dirt ;  and 

That,  in  the  final  analysis,  therefore,  the  causes  of  infant 
morbidity  and  mortality  are  chiefly  sociological,  psychological 
and  economic,  a  combination  of  ignorance,  carelessness,  indif- 
ference, neglect,  filth,  vice  and  poverty. 

Thus  it  was  found  in  a  study  of  44,226  deaths  under 
age  one,  in  New  York,  Philadelphia,  Boston  and  Chicago, 
that  acute  gastro-intestinal  disorders  were  responsible 
for  28  per  cent,  and  acute  respiratory  diseases  for  18.5 
per  cent  of  the  deaths  (L.  E.  Holt)  ;  while  the  correspond- 
ing mortality  figures  in  England  and  Wales  during  the 
period  from  1892  to  1901  were  57.5  per  cent  and  25.3 
per  cent,  respectively.  Of  the  49,000  infants  who  die 
under  the  age  of  two  every  year  in  the  United  States  from 


250    MENTAL  HEALTH  OF  SCHOOL  CHILD 

cholera  infantum,  it  is  maintained  that  the  majority  are 
poisoned  by  flies. 

Moreover,  the  euthenist  contends  that  the  real  causes 
are  often  mistakenly  or  fraudulently  reported.  Thus 
premature  births  or  still  births,  which  constitute  about  25 
per  cent  of  tlie  mortality  figures  both  in  England  and 
America,  and  which  are  alleged  to  be  due  to  impairment 
of  biological  capital  or  neuropathic  taint,  are  often  due 
to  abortion  produced  by  abortifacients  or  criminal  opera- 
tions, or  to  infanticide,  or  to  overwork  and  starvation  of 
the  mothers  (as  they  are  frequently  found  among  factory 
mothers).  Likewise  in  some  cases  in  which  the  cause  is 
reported  as  parental  alcoholism,  the  inebriety  is  only 
indirectly  responsible  for  the  deaths.  Often  the  real  cause 
is  overlaying — the  crusliing  or  smothering  of  the  infant 
by  the  narcotized  parent.  This  circumstance  seems  to 
explain  why  so  many  infants  die  between  Saturday  night 
and  Sunday  morning — 42  per  cent  of  461  cases  reported 
in  an  English  study. 

With  the  emphasis  placed  on  such  factors  as  the  above, 
it  is  evident  that  the  euthenist  will  look  to  the  control  of 
environmental  factors  for  his  orthogenic  measures.  Among 
the  control  measures  which  may  be  mentioned  are  the 
following : 

The  complete  extermination  of  the  house  fly; 

The  establishment  of  scientific  standards  of  ante-  and  post- 
natal maternity  and  infancy  nurture  and  care ; 

Relieving  mothers  from  excessive  toil,^  hunger  or  emotional 
tension  before,  during  and  following  the  period  of  confinement, 

3  'Women  who  toil  at  wearisome  work  up  to  the  final  hour  give 
birth  to  children  inferior  in  weight  to  those  born  of  mothers  who  have 
given  themselves  up  to  rest  and  quiet  for  some  time  before  the 
expected  birth.' — Pinard. 


CHILD  ORTHOGENESIS  251 

by  the  establishment  of  expectant  refuges,  lying-in  hospitals  or 
maternity  nurseries,  or  nursing  mothers'  restaurants,  where 
wholesome  food  may  be  dispensed  to  the  mother  free  of  charge 
or  at  small  expense,  or  by  the  legislative  pensioning  or  endow- 
ment of  motherhood,  or  by  the  issuing  of  a  form  of  motherhood 
insurance ; 

The  compulsory  registration  and  periodical  inspection  of 
baby  farms  or  foundling  homes  ; 

The  licensing  and  supervision  of  foster  mothers ; 

The  establishing  of  medically  supervised  milk  stations  or 
social  consultation  centers,  where  properly  modified,  pasteur- 
ized or  sterilized  milk  may  be  supplied,  and  where  mothers 
may  receive  instruction  and  witness  demonstrations  in  the 
scientific  care  of  infants;  or  the  establishment  of  community 
educational  health  centers  of  the  Milwaukee  type,  for  the 
training  of  mothers,  nurses,  social  workers,  midwives*  and 
doctors  in  infant  feeding,  care  and  hygiene,  and  in  home  and 
neighborhood  sanitation ; 

The  establishing  of  public  summer  baby  tents ; 

The  development  of  measures  to  substitute  breast  feeding^ 
for  bottle  feeding; 

The  legal  imposition  of  fines  on  mothers  who  can  but  will 
not  nurse  their  sickly  babies ; 

The  substitution  by  legal  enactment  of  bottle  teats  for  bottle 
tubes ; 

The  frequent  systematic  inspection  of  the  mouths  of  young 
children  adequately  to  control  the  'disease  of  the  people,' 
dental  caries ; 

The  after-care  or  supervision  of  sick  children  during  con- 
valescence ; 

4  Our  first  municipal  school  for  midwives  was  established  in  New 
York  in  1911. 

5  Children  fed  at  the  mother's  breast  double  their  weight  at  the 
end  of  the  fifth  month,  and  treble  it  at  the  end  of  the  twelfth  month, 
while  those  bottle-fed  double  only  at  the  end  of  the  first  year,  and 
treble  only  in  the  course  of  the  second  year. 


252    MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  expert  community  supervision  of  infants  until  they 
statutorily  come  under  the  supervision  of  school  boards ; 

The  systematic  (annual  or  biennial)  examination  of  pupils 
in  the  schools  by  medical  and  psychological  inspectors,  with  a 
view  to  the  discovery  and  correction  of  physical  disabilities 
and  mental  deviations  or  abnormalities ;  whether  developed  or 
latent  f 

The  community  supervision,  regulation  and  socialization  of 
urban  recreation ; 

The  education  of  the  youths  of  both  sexes  in  sex  hygiene; 
and 

The  education  of  girls  and  young  wives  for  motherhood  in 
little-mothers'  classes  or  in  continuation  home  schools. 

Concerning   the   desirability   of  instituting  systematic, 

organized  plans  for  putting  into  effect  some  of  the  above 

measures,  there  ought  to  be  little  difference  of  opinion. 

There  is,  at  least,  little  reason  to  doubt  the  efficacy  of 

many  of  these  measures.     To  cite  merely  four  instances : 

by   the   employment   of  various   corrective,   remedial   and 

preventive  measures  in  New  York  City  the  infant  death 

rate  between  1881  and  1902  was  reduced  62  per  cent;  by 

providing  infant  supervision  by  means  of  district  nurses 

the  mortality  in  New  York  City  last  year  was  reduced  to 

1.4  per  cent  among  16,987  supervised  babies  (the  cost  of 

the  supervision  amounted  to  about  fifty  cents  per  child 

per  month — the  same  as  in  Milwaukee)  ;  by  arranging  to 

give  mothers  a  ten-day  rest  period  before  confinement  10 

per  cent  was  added  to  the  weight  of  infants  in  Paris ;  and 

fi  The  last  two  measures  are  partly  in  practical  force  in  New  York 
City  (and  Boston),  where  a  Division  of  Child  Hygiene,  of  the  Depart- 
ment of  Health,  has  been  established  under  municipal  control  with 
the  duty  of  supervising  the  health  of  children  from  birth  to  the  legal 
working  age.  It  is  some  such  community  organization  as  this  for 
which  I  shall  plead,  though  I  prefer  to  have  it  established  as  a  part 
of  the  public  school  system,  with  various  additions  to  its  functions. 


CHILD  ORTHOGENESIS  253 

by  the  simple  expedient  of  feeding  infants  from  the  breast 
instead  of  from  the  bottle  the  mortality  in  various  cities 
has  been  reduced  in  amount  varying  from  fifteen  per  cent 
to  several  hundred  per  cent. 

Obviously,  the  first  efforts  of  any  organized  plan  of 
human  conservation  should  aim  so  to  environ  every  babe 
that  it  may  obtain  a  decent  fighting  chance  for  survival 
beyond  the  cradle.  By  the  proper  control  of  environ- 
mental factors  I  believe  that  we  can  eradicate  75  per  cent 
of  infant  mortality,  provided  the  work  is  organized  on  a 
community  basis  instead  of  being  left  to  individual  initia- 
tive or  direction.  Individual  effort,  because  of  ignorance, 
caprice,  poverty  or  inefficiency,  will  mean  desultory  or 
worthless  action,  or  no  action  at  all.  Nothing  short  of 
organized  community  action  will  enable  us  to  eradicate 
the  preventable  mortahty  of  infants.  My  first  plea, 
therefore,  is  for  the  development  of  comprehensive  plans 
on  a  community  basis  for  preserving  and  conserving  the 
lives  of  infants. 

But  I  shall  equally  lay  stress  upon  a  second  desideratum, 
namely  the  organization  of  community  development  super- 
vision of  the  child  during  the  entire  growth  period.  That 
there  is  need  of  such  supervision  in  this  day  of  disinte- 
grating homes  there  can  be  no  doubt.  The  problem  of 
the  individual  child  only  begins  after  the  battles  of  the 
first  years  of  life  have  been  won,  and  after  the  child  has 
become  more  or  less  emancipated  from  dependence  on  his 
mother  or  caretaker.  The  momentous  period  of  individual- 
ization which  now  begins  is  fraught  with  grave  perils  at 
every  turn.  All  along,  the  child  will  have  to  cope  with  in- 
sidious destructive  environmental  influences  which  tend  to 
abort,  deflect  or  retard  his  normal  development.  Can  we 
safely  entrust  the  responsibility  for  normal  development 


254    MENTAL  HEALTH  OF  SCHOOL  CHILD 

under  modern  urban  conditions  to  the  child  or  parent?  Do 
not  practically  all  children  and  most  parents  lack  the 
requisite  knowledge,  insight  and  foresight?  Is  it  not, 
therefore,  the  duty  of  the  community  or  state  to  supple- 
ment the  home  care,  and  systematically  to  direct  the  child's 
development,  so  that  he  may  come  to  a  true  knowledge  and 
appreciation  of  the  ideals  which  the  state  regards  as  essen- 
tial to  its  perpetuity?  Clearly  it  is  in  the  interest  of  the 
state  that  the  cliild  be  so  safeguarded  from  injury  and 
disease  and  so  trained  that  he  may  reach  his  maximal 
physical,  mental  and  moral  potential,  to  the  end  that  he 
may  become  a  productive  civic  unit  and  not  a  social  drag. 
That  the  state  has  already  assumed  a  paternalistic 
function  toward  her  children  is  shown  by  the  general  estab- 
lishment of  compulsory  systems  of  public  day  schools  and 
special  institutions,  and  by  the  more  recent  establishment 
of  systems  of  school  medical  inspection.  While  I  am  of  the 
opinion  that  the  public  school  systems  are  the  community's 
logical  agency  for  accomplishing  the  orthogenic  work 
required  by  the  infant  as  well  as  the  child,  neither  the 
public  schools  nor  the  school  medical  inspection  systems 
have  as  yet  been  adequately  organized  to  carry  out  a 
satisfactory  program  of  orthosomatic  and  orthophrenic 
work.  The  public  schools  are  making  heroic  attempts  to 
adapt  their  machinery  to  the  varying  physical  and  mental 
needs  of  all  pupils,  but  school  officers  and  administrators 
have  thus  far  failed  to  appreciate  that  the  mental  and 
educational  problems  connected  with  the  mentally  excep- 
tional child  cannot  properly  be  handled  until  the  direction 
of  the  work  is  taken  out  of  the  hands  of  the  dilettanti  and 
placed  in  the  hands  of  psycho-educational  experts,  who  are 
not  only  skilled  In  methods  of  psycho-clinical  diagnosis, 
but   who   are   also   capable   of   functioning  as   consulting 


CHILD  ORTHOGENESIS  255 

experts  in  the  various  branches  of  corrective  pedagogy. 
Likewise  school  medical  inspection  has  failed  to  deliver, 
partly  (1)  because  many  school  medical  inspectors  have 
no  specialized  training  in  the  diagnosis  of  the  physical  and 
nervous  defects  of  children,  and  lack  expert  knowledge  of 
school  hygiene  and  sanitation  and  the  prevention  of 
defects  and  disorders;  partly  (2)  because  the  work  is 
confined  almost  entirely  to  mere  inspection  and  tabulation 
of  defects  instead  of  including  corrective  treatment,  with 
the  result  that  in  many  schools  the  percentage  of  pupils 
who  actually  have  their  handicaps  removed  varies  from 
5  to  25  per  cent;^  and  partly  (3)  because  emphasis  is 
placed  almost  entirely  on  the  discovery  and  correction  of 
existent  defects,  instead  of  on  the  discovery  and  prevention 
of  the  causes  of  the  defects  (that  is,  the  conditions  which 
produce  adenoids,  enlarged  tonsils,  carious  teeth,  etc.). 

In  order  that  the  schools  may  serve  as  an  organized 
agency  for  carrying  out  an  effective  program  of  ortho- 
genic work  for  every  cliild  of  school  age,^  the  following 
plan  of  work  is  proposed : 

1.  Every  child  on  entering  school  should  be  given  an 
expert  examination  for  the  detection  of  latent  or  manifest 
abnormalities  of  mental,  moral  and  physical  development, 
the  mental  examination  to  be  made  by  a  skilled  clinical 

7  In  a  Chicago  school  the  principal  told  me  that  in  one  of  her 
investigations  she  found  that  only  5  per  cent  of  the  defective  pupils 
had  taken  any  measures  to  have  their  defects  removed.  It  is  said  that 
in  New  York  last  year,  as  a  result  of  visits  to  the  pupils'  homes  by 
inspectors  and  nurses,  86  per  cent  of  the  defects  discovered  were 
treated. 

8  The  schools  may  well  care  for  the  child  from  the  time  of  birth,  in 
the  department  of  orthogenics  which  I  propose.  This  would  entail 
the  employment  of  nurses,  who  would  devote  themselves  to  the  care 
of  babies  and  young  children.  All  the  records  would  be  filed  in  the 
one  central  school  bureau. 


256    MENTAL  HEALTH  OF  SCHOOL  CHILD 

psychologist  who  is  an  expert  in  psycho-cHnical  methods 
and  in  the  differential,  corrective  pedagogy  adapted  to 
various  types  of  mental  deviates ;  and  the  physical  exami- 
nation to  be  made  by  a  physician  specially  trained  in  the 
detection  of  the  diseases,  the  physical  defects,  the  nervous 
disorders  and  phy  si  co-developmental  abnormalities  of 
childhood. 

2.  Children  found  in  these  examinations  to  be  mentally 
or  physically  deviating  should  immediately  receive  appro- 
priate orthogenic  treatment,  whether  this  be  hygienic, 
corrective  or  preventive,  or  whether  it  be  physiological, 
pedagogical  or  psychological.  By  thus  securing  diagnosis 
and  treatment  wliile  the  child's  brain  is  plastic  we  shall  be 
able  to  accomplish  the  highest  orthogenic  results.  We 
shall  be  able  to  prevent  the  formation  of  injurious  peda- 
gogical habits  which  result  from  the  malfunctioning  of  the 
psycho-physical  organism  and  wliich,  once  established,  are 
often  hard  to  eradicate.  To  obtain  maximal  results,  the 
child  deviate  must  be  classified  early. 

3.  Specially  trained  teachers,  and  special  classes  or 
institutions  should  be  provided  for  the  mental  and  physical 
deviates.  School  medical  and  dental  dispensaries  should 
be  established  for  the  free  treatment  of  all  properly  certi- 
fied indigent  cases.  It  is  economic  suicide  for  the  state 
to  pay  for  the  education  of  pupils  who  are  largely  unedu- 
cable  because  of  physical  handicaps.  To  spend  large 
sums  of  money  in  the  discovery  of  physical  handicaps 
without  providing  the  machinery  for  the  rectification  of 
defects  is  also  economic  suicide. 

4.  Physical  training  should  be  systematically  required 
of  every  child  during  his  entire  school  course.  Health 
education  must  be  given  the  same  emphasis  as  mental 
education. 


CHILD  ORTHOGENESIS  257 

5.  Children  shown  by  the  expert  examinations  and  the 
results  of  special  training  to  be  socially  and  mentally 
incompetent,  should  be  segregated  in  colonies  for  perma- 
nent oversight.  They  should  be  sent  to  such  institutions 
as  soon  as  their  incompetency  is  measurably  certain,  at 
least  before  they  reach  puberty.  No  mental  incompetents 
should  be  permitted  at  large  in  society,  unless  the  home 
situation  is  such  as  to  insure  adequate  protective  oversight 
for  the  child. 

6.  The  medical  and  psychological  work  throughout 
should  contemplate  not  only  the  discovery  and  correction 
of  defects  or  deviations  which  interfere  with  normal 
development,  but  also  the  discovery  and  removal  of  the 
conditions,  whatever  their  nature,  which  produce  physical 
or  mental  disabilities.  The  keynote  of  the  whole  plan  must 
be  prevention  rather  than  cure.  The  problem  does  not  so 
much  concern  the  excision  of  adenoids  or  enlarged  tonsils, 
as  the  removal  of  the  conditions  which  cause  them. 

There  is  not  space  to  argue  the  practical  efficacy  of  a 
comprehensive  program  of  orthogenic  work  along  the  line 
indicated  above,  but  reference  may  be  made  to  the  experi- 
ment described  in  Chapter  XIII,  which  was  undertaken 
to  discover  whether  or  not  the  mental  efficiency  of  a  group 
of  children  actually  could  be  raised  by  orthosomatic  mouth 
treatment.  The  bearing  of  this  experiment — it  showed 
that  the  mentahty  of  children  could  be  heightened  by  the 
proper  care  and  use  of  the  oral  cavity — is  not  only 
economic  (the  financial  waste  resulting  from  trying  to 
teach  pupils  whose  capacity  for  development  is  partially 
blocked  by  physical  disabilities)  or  moral  and  humani- 
tarian (the  inhumanity  and  cruelty  of  forcing  children  to 
battle  through  the  grades  against  heavy  physical  handi- 
caps) but  also  eugenic.     There  are  probably  few  physi- 


258    MENTAL  HEALTH  OF  SCHOOL  CHILD 

cal  defects  which  do  more  to  impair  the  constitutional 
vigor  of  the  individual  than  the  insanitary  mouth.  The 
damage  done  to  the  individual  by  an  unhygienic  oral 
cavity  has  been  said  to  exceed  the  damage  done  by  alcohol. 
Be  this  as  it  may,  whatever  impairs  the  constitutional 
vigor  of  the  individual  will  probably,  in  the  long  run, 
impair  the  racial  vigor. 

I  incline  to  the  unorthodox  view  that  there  is  a  eugenical 
side  to  euthenical  reclamation  work.  It  is  possible,  I 
believe,  by  the  orthosomatic  and  orthophrenic  work  sug- 
gested above,  gradually  to  elevate  the  vital  index  of  the 
growing  generation  and  thus  eventually  to  improve  the 
inheritable  qualities  of  the  race.  Will  not  a  slow  ortho- 
genic transformation  of  the  somatic  protoplasm  gradually 
produce  a  beneficent  transformation  of  the  germinal  pro- 
toplasm, just  as  the  continuous  indulgence  in  alcohol  is 
thought  by  some  investigators  to  produce  a  gradual 
deterioration  of  the  reproductive  cells? 

Whether  or  not  this  view  is  scientifically  justifiable,  I 
want  specially  to  emphasize  the  following  vital  eugenical 
aspect  of  the  above  community  plan  of  school  orthogenic 
work,  namely:  the  truth  that  the  practical  efficacy  of 
applied  eugenics  largely  depends  on  the  systematic  study 
of  children  in  the  schools,  so  that  all  eugenically  unfit 
children  may  be  identified  during  the  prepubescent  years. 
Only  through  systematic  cooperative  child  study  on  the 
part  of  teacher,  educator,  psychologist,  biologist  and  phy- 
sician will  we  be  enabled  to  distinguish  with  certainty  be- 
tween the  transmissible  and  therefore  eugenically  impor- 
tant qualities  and  the  non-heritable  and  therefore  eugeni- 
cally irrelevant  qualities,  so  that  our  eugenic  duty  toward 
a  given  child  may  be  patent  certainly  not  later  than  at  the 
dawn    of    adolescence.      The    urgent    need    for    improved 


CHILD  ORTHOGENESIS  259 

differential  eugenical  diagnoses  will  appear  presently. 
But  before  proceeding  further  let  us  summarize  the  argu- 
ment of  the  preceding  pages  : 

It  is  the  inalienable  right  of  every  child  born  into  the 
world,  whether  fit  or  unfit,  to  receive  such  parental  and 
community  care  as  shall  remedy  or  prevent  sickness  and 
disease,  and  as  shall  correct  or  mitigate  constitutional  or 
acquired  physical  defects  and  mental  and  moral  disa- 
bilities, to  the  end  that  he  may  be  able  to  appropriate  in 
maximal  degree  the  instruction  and  training  which  the 
community  bestows  upon  him,  and  to  the  end  that  he  may 
become  a  fit  progenitor  of  healthy  offspring. 

But  if  this  proposition  be  true,  is  it  not  equally  true  that 
it  is  the  inalienable  right  of  every  child  to  be  well  born,  to 
be  saved  from  impending  death,  premature  decrepitude  or 
inaptitude  before  instead  of  after  birth?  Otherwise  stated, 
is  it  not  the  inalienable  right  of  the  state  to  demand  that 
no  socially  unfit  stock  shall  be  bora,  and  to  enforce  that 
demand  by  all  the  police  power  which  it  possesses?  To 
these  questions  the  eugenist  makes  affirmative  reply. 

Eugenics 

The  eugenist  affirms  that  human  beings,  like  the  lower 
animals,  breed  true.  Like  produces  like,  fit  answereth 
unto  fit,  unfit  follows  unfit.  Therefore  the  problem  of 
human  orthogenics  is  fundamentally  a  problem  of  breed- 
ing viable,  untainted  infants  by  means  of  eugenically  fit 
matings. 

If  the  euthenist  has  unbounded  faith  in  the  efficacy  of 
the  environment,  the  eugenist  has  a  no  less  religious  faith 
in  his  heredity  formularies.     We  are  told : 

That  the  influence  of  the  environment  is  less  than  one-fifth, 
nay,  less  than  one-tenth,  that  of  heredity  (Karl  Pearson)  ; 


260    MENTAL  HEALTH  OF  SCHOOL  CHILD 

That  most  infant  deaths  are  due  to  lack  of  biological  capital, 
or  to  constitutional  inferiority,  and  the  resultant  increased 
susceptibility  to  disease; 

That  the  issue  born  of  precocious  marriages  (before  the 
parents*  organisms  have  attained  their  maturity)  are  bio- 
logically and  psychologically  inferior  ('Sterility  often  results, 
or  children  are  born  with  lessened  chances  of  survival.  The 
greatest  child  mortality  comes  from  unions  contracted  at  six- 
teen or  earlier,  and  the  lowest  from  unions  contracted  from 
twenty-nine  to  thirty-two.' — Quetelet.  'The  heaviest  infants 
are  born  of  mothers  between  twenty-five  and  thirty.' — Mathews 
Duncan.  'Mothers  who  at  the  birth  of  their  first  child  weigh 
less  than  fifty-five  kilograms  and  are  under  twenty  years  of 
age,  have  children  of  inferior  weight.' — Schafer.  Most 
famous  men  have  been  begotten  of  parents  between  twenty-five 
and  thirty-six  years  of  age)  ; 

Short  intervals  between  pregnancies  interfere  with  the 
normal  progressive  increase  in  the  weight  of  later  births 
(Wernicke)  and  thus  presumably  lead  to  inferior  stocks ; 

That  30  per  cent  of  infant  mortality  is  due  to  inherited  or 
congenital  syphilis  alone ; 

That  syphilis  is  the  chief  cause  of  abortion; 

That  syphilis  causes  tardy  growth  in  the  child  {e.g.,  normal 
children  regain  their  weight  at  the  end  of  one  week,  syphilitics 
at  the  end  of  two  weeks),  and  sometimes  infantilism; 

That  the  congenitally  syphilitic  child  is  far  more  prone  to 
contract  the  various  contagious  diseases  than  the  non- 
syphilitic  ; 

That  more  than  one-third  of  tubercular  cases  in  institutions 
come  from  tubercular  families,  which  it  is  assumed  are  tuber- 
cular because  of  inherited  tubercular  diathesis ; 

That  from  60  to  90  per  cent  (Tredgold)  of  the  amented 
feeble-minded  are  hereditary  cases,  and  that  a  large  percentage 
of  the  insane  (16  per  cent,  Koch),  epileptic  (56  per  cent,  Barr 
and  Spratling)  and  criminals  and  social  offenders  are  the 
victims  of  heredity; 


CHILD  ORTHOGENESIS  261 

That  alcohol  is  a  veritable  race  poison,  producing  both 
individual  and  racial  degeneracy; 

That  parental  alcoholism  causes  atrophy  or  pathological 
changes  of  the  reproductive  mechanism ; 

That  it  is  responsible  for  5  to  20  per  cent  of  feeble- 
mindedness and  epilepsy,  30  per  cent  of  male  insanity  and  a 
large  percentage  of  pedagogical  backwardness  in  school  chil- 
dren, for  a  large  percentage  of  mortality  soon  after  birth,  for 
infantilism,  deformities,  nervous  disorders,  deficiencies  of 
weight  and  disease  in  children,  and  for  the  inabilty  of  mothers 
to  nurse  their  offspring  (Bunge  found  that  only  2.1  per  cent 
of  daughters  of  confirmed  drunkards  were  able  to  suckle  their 
infants)  ; 

That  female  inebriety  particularly  is  a  prolific  cause  of  the 
ruin  of  infant  life,  inebriety  in  the  expectant  mother  being 
responsible  for  a  large  percentage  of  sterility,  abortion,  mis- 
carriages, premature  births  and  still  births,  and  retarded  and 
unsymmetrical  growth  in  the  embryo  (W.  C.  Sullivan:  only  42 
per  cent  of  600  children  of  120  female  inebriates  lived  more 
than  two  years;  55.8  per  cent  lived  less  than  two  years. 
Lonnett:  of  107  English  women  dying  of  alcoholism  before 
twenty-nine  years  old,  8  bore  no  children,  99  bore  6  delicate 
and  deformed  children ;  but  29  vigorous  children  were  born 
before  the  mothers  became  alcoholic.  Some  pregnant  Swiss 
women  alcoholize  in  order  to  reduce  the  size  of  the  child,  so 
as  to  avoid  the  pains  of  birth)  ; 

That  the  death  rate  is  greatest  for  the  later  pregnancies  of 
maternal  inebriates  (33.7  per  cent  of  deaths  among  first  born; 
72  per  cent  among  the  sixth  to  the  tenth  born;  still  births 
among  the  first  born,  6.2  per  cent;  among  last  born,  17.2  per 
cent) ; 

That  increase  in  national  sobriety  has  actually  been  attended 
with  a  decrease  in  infant  mortality  (English  study.  Latenen's 
study  of  20,000  from  5,846  families  indicated  that  the  number 
of  deaths  and  miscarriages  decreased  as  the  amount  of  alcohol 
consumed  decreased)  ; 


262    MENTAL  HEALTH  OF  SCHOOL  CHILD 

But  that  both  the  number  of  premature  and  still  births  and 
the  number  of  infants  who  barely  escape  these  conditions  are 
increasing  in  civilized  countries  (Kaye,  whose  finding  is  based 
on  English  statistics),  while  likewise  our  neuropathic  stock  is 
increasing  faster  than  the  general  population,  so  that  the  army 
of  dependents,  defectives  and  delinquents  threatens  to  engulf 
our  civilization  (one  medical  alarmist,  Kellogg,  predicts  that 
in  the  year  2012  no  children  at  all  will  be  born!)  ; 

That  the  preservation  of  unfit  babies  by  euthenical  means 
materially  augments  the  increase  of  the  degenerates ; 

That  state  systems  of  granting  annual  bonuses  or  allowances 
for  each  child  born  are  pernicious,  because  only  that  part  of 
the  population  which  is  barely  living  above  the  poverty  line 
would  take  advantage  of  them,  and  this  would  tend  to  augment 
the  ranks  of  the  lower  social  strata ; 

That  material  prosperity,  eugenically  considered,  is  no 
panacea  for  racial  degeneracy,  because  it  tends  to  produce 
alcoholism,  premature  debauchery  and  syphilis  (as  shown  by 
a  study  of  prosperity  in  the  wine-producing  canton  of  Luchon, 
France.     See  p.  272)  ; 

That  the  potential  limits  of  every  individual's  level  of  func- 
tioning are  quite  definitely  fixed  by  heredity;  that  since  the 
limits  cannot  be  radically  altered  or  lifted  by  nurture  or 
training,  each  individual  will  tend  to  achieve  his  maximal 
success  only  in  so  far  as  he  follows  his  initial  aptitudes,  pro- 
pensities or  bent ;  and  that  therefore  the  improvement  of 
human  capacity  is  primarily  a  matter  of  eugenical  mating  and 
only  secondarily  a  matter  of  teaching  and  training. 

What  now  are  the  measures  which  are  proposed  by  the 
eugenist  for  elevating  the  standard  of  parenthood.-^  The 
strictly  eugenical  measures  have  to  do  either  with  the 
regulation  of  reproduction  or  mating,  i.e.,  scientific  breed- 
ing; or  with  the  protection  of  the  germ  plasm  from  injury 
or  deterioration   (and  possibly  with  the  safeguarding  of 


CHILD  ORTHOGENESIS  263 

the  fetus  from  injury,  starvation  or  infection).  The  spe- 
cific measures  most  frequently  advocated  are  the  enforced 
Hmitation  of  marriages  to  the  eugenically  fit,  as  deter- 
mined by  statutorily  required  physical  and  mental  exami- 
nations of  applicants  for  marriage  certificates ;  the  com- 
pulsory sterilization,  under  legal  safeguards,  of  all 
persons  adjudged  socially  incompetent ;  the  quarantining 
of  all  persons  who  are  carriers  of  infectious  social  dis- 
eases ;  and  the  permanent  sequestration  in  state  colonies 
of  all  the  epileptic,  insane  and  feeble-minded,  chronic 
inebriates,  syphilitics,  rapists  and  sexual  perverts. 

The  student  of  orthogenics  finds  himself  in  sympathetic 
accord  with  the  fundamental  aims  of  the  eugenic  move- 
ment. In  our  efforts  to  fashion  a  race  of  human  thorough- 
breds nothing  less  than  the  eugenical  ideal  is  wholly  satis- 
fying. Moreover,  we  have  a  right  to  judge  any  proposed 
euthenical  measure  in  the  light  of  the  eugenical  ideal.  Any 
euthenical  measure  which  is  manifestly  anti-eugenical 
should  not  be  encouraged.  Legislators  may  well  pause 
before  favorably  considering  those  measures  now  being 
advocated  in  various  ci\nlized  nations  which  are  threatened 
with  depopulation.  The  probable  immediate  effect  of 
paying  bounties  out  of  the  public  treasury  to  mothers  for 
the  support  of  babies  would  be  the  increase  of  neuropathic 
stock,  so  that  society  would  ultimately  succumb  under  the 
ever  increasing  burden.  But  while  the  eugenical  concep- 
tion is  impregnable  as  an  ideal,  the  student  who  is  seriously 
interested  in  the  cause  of  eugenics  must  recognize  that 
there  are  almost  insuperable  difficulties  in  the  way  of  the 
effective  application  of  its  principles,  and  that  progress 
in  the  work  will  depend  upon  the  measure  in  which  these 
difficulties  are  successfully  overcome.  We  may  group  these 
difficulties  into  four  classes : 


264    MENTAL  HEALTH  OF  SCHOOL  CHILD 

1.     Psychological  and  sociological  difficulties. 

Effective  reform  of  human  practices  is  scarcely  possible 
without  the  aid  of  the  emotional  forces  of  human  nature. 
But  man's  emotional  development  has  not  kept  pace  with 
his  intellectual  progress.  Emotionally,  human  nature  is 
very  much  the  same  today  that  it  was  in  the  days  of 
primitive  man.  This  is  explainable  on  the  assumption  that 
the  emotions  are  merely  the  subjective  side  of  the  instincts, 
and  instincts  are  relatively  fixed.  Therefore,  in  trying  to 
transform  the  sex  life  of  the  race  we  are  obhged  to  deal 
with  a  set  of  emotions  which  are  connected  with  one  of  the 
three  oldest  and  most  basal  instincts  of  the  race,  namely 
the  sexual  instinct.  Now,  it  is  at  least  supremely  difficult, 
if  not  utterly  impossible,  suddenly  to  change  instinctive 
racial  reactions  by  mere  instruction,  demonstration,  exhor- 
tation or  legal  enactment.  An  instinct  has  become  deeply 
imbedded  in  the  very  fabric  of  the  psycho-biological  life 
of  the  individual  as  a  result  of  age-long  racial  conflicts, 
by  slow  and  painful  processes  of  elimination  and  survival. 
Therefore,  instincts  have  acquired  a  degree  of  stability, 
pertinacity  and  emotional  intensity  which  renders  them 
almost  invulnerable  to  merely  rational  appeal,  and  which 
leaves  but  one  way  to  transform  them,  namely  the  evolu- 
tionary method  of  gradual  elimination  and  survival. 

To  illustrate :  as  a  result  of  thousands  of  years  of  pain- 
ful tribal  struggle  and  warfare  those  tribes  were  gradually 
selected  for  survival  which  abandoned  the  practice  of  con- 
sanguineous marriage  and  incestuous  intercourse  between 
near  relatives.  Through  painful  experience  the  inexorable 
truth  was  slowly  forced  into  the  consciousness  of  the  race 
that  such  unions  weakened  the  stamina  of  the  tribe,  and 
therefore  must  be  rigorously  interdicted.     Not  only  did 


CHILD  ORTHOGENESIS  265 

such  practices  arouse  the  disapproval,  contempt  and  con- 
demnation of  the  organization,  but  they  gradually  awak- 
ened in  the  individual  a  feeling  of  disgust  which  in  time 
became  instinctive.  The  intense  repugnance  which  the 
normal  mind  today  feels  toward  consanguineous  or  incestu- 
ous intercourse  rests  more  upon  an  instinctive  than  a 
rational  basis.  The  taboo  pronounced  on  such  unions  as 
these  is  founded  on  the  deepest  psychic  subsoil  of  the  racial 
consciousness,  and  has  become  incorporated  in  the  very 
habitudes,  customs  and  traditions  of  the  race,  obtaining 
thereby  a  sanction  which  is  more  authoritative  than  that 
conferred  by  command  or  arbitrary  legal  enactment. 

The  eugenic  problem  would  be  easily  solved  if  there 
existed  a  racial  instinct  of  repulsion  against  anti-eugenical 
matings — if  there  were  a  universally  instinctive  taboo  on 
marriages  between  the  biologically  unfit.  It  is  a  question 
whether  such  a  feeling  of  disgust,  instinctive  in  its  ele- 
mental intensity,  can  be  instilled  into  the  consciousness  of 
lovers  by  mere  teaching,  enlightenment  or  prohibition. 
Sexual  attraction  is  an  instinctive  psycho-biological  phe- 
nomenon less  subject  to  regulation  by  scientific  or  legal 
prescription  than  by  blind  impulse,  custom,  tradition  or 
convention.  Most  free  matings  will  be  determined  by 
certain  intangible  secondary  sexual  characteristics,  certain 
fetiches  peculiar  to  each  individual,  while  the  restricted 
matings  will  be  determined  by  the  conventional  require- 
ments of  social  station  and  wealth — unless,  indeed,  the 
eugenic  creed  can  be  transformed  into  a  vital,  national 
religion. 

Just  as  there  are  deep-seated  psychological  instincts  or 
emotional  forces  which  tend  to  frustrate  the  enforcement 
of  eugenic  marriages,  so  the  racial  instinct  of  sexual 
modesty  will  offer  the  hardest  obstacle  to   the   effective 


266    MENTAL  HEALTH  OF  SCHOOL  CHILD 

and  universal  enforcement  of  laws  requiring  health  exami- 
nations before  marriage  licenses  may  legally  be  issued. 
Even  if  such  laws  were  generally  enacted,  will  not  the 
forces  of  sex  frequently  overleap  all  legal  restraints  and 
defy  prisons  and  chains? 

In  the  same  way,  the  chief  obstacles  to  the  legal  en- 
forcement of  the  practice  of  vasectomizing  the  unfit  are  of 
a  psychological  nature — various  sentiments  and  preju- 
dices, and  man's  instinctive  recoil  against  any  interference 
with  the  processes  or  impulses  of  nature.  If  it  were  possi- 
ble to  vasectomize  the  whole  army  of  misfits,  and  to  stop 
entirely  the  manufacture  of  alcohol  throughout  the  earth, 
the  problem  of  eugenics  would  be  largely  solved.  The 
chief  obstacle  against  the  total  elimination  of  the  liquor 
curse,  again,  is  also  psychological — the  instinct  of  appe- 
tite and  certain  mental  states  which  are  induced  by  the 
consumption  of  narcotics. 

Finally,  there  are  the  miaternal  instinct  and  filial  ties  to 
thwart  any  effective  plan  of  colonizing  without  exception 
all  degenerates  or  eugenical  misfits. 

It  has  been  necessary  thus  to  emphasize  the  fact  that 
there  are  certain  psychological  forces,  certain  instincts, 
emotions,  customs,  conventions  and  folk  ways,  which  are 
anti-eugenic  in  nature,  and  which  must  be  reckoned  with  in 
any  well-conceived  plan  of  eugenics.  The  fact  that  these 
eugenically  hostile  forces  exist  in  the  very  citadel  of 
humanity  makes  it  all  the  more  essential  that  the  eugenist 
wage  a  relentless  campaign  for  the  increase  and  dissemina- 
tion of  verifiable  and  convincing  knowledge  of  heredity,  so 
that  eugenic  truths  may  lay  hold  on  the  deepest  feelings 
and  sentiments  of  the  race  and  become  in  fact  a  national 
faith,  tradition  or  religion.     Then  will  it  be  possible  to 


CHILD  ORTHOGENESIS  267 

make  eugenic  enactments  on  the  statute  books  genuinely 
effective. 

2.  Administrative  and  legal  difficulties. 

The  adequate  enforcement  of  eugenical  measures  in  the 
present  stage  of  civihzation  requires  much  governmental 
machinery.  But  because  of  the  facts  which  we  have  just 
considered,  it  is  not  probable  that  adequate  laws  can  be 
secured,  or  can  be  enforced  if  secured.  Public  sentiment 
would  not  support  the  enormous  legislative  levies  which 
would  be  needed  to  colonize  the  vast  army  of  misfits 
(already  in  New  York  from  one-fifth  to  one-seventh  of  the 
state  revenues  go  to  the  support  of  the  institutions  for 
defectives)  ;  and  the  popular  outcry,  based  on  prejudice, 
blind  emotion,  impulse  or  instinct,  against  the  sterilization 
of  at  least  all  those  misfits  who  remained  at  large  in 
society,  would  nullify  the  law.  As  a  consequence,  a  large 
number  of  degenerates  would  always  be  found  in  society 
polluting  the  race  stream.  Compulsory  physical  and 
mental  examinations  of  all  parties  to  marriage  contracts 
would  serve  a  useful  eugenic  purpose ;  but  the  laws  would 
be  powerless  to  prevent  a  man  or  woman  from  contracting, 
say,  contagious  venereal  diseases  after  the  bill  of  health 
had  been  issued.  After  all,  the  problem  is  not  so  much  to 
get  proper  laws  enacted  as  to  secure  the  public  sentiment 
wliich  will  demand  their  enforcement.  There  is  no  remedy 
for  these  difficulties,  except  a  campaign  of  discovery  and 
diffusion  of  eugenic  facts,  so  that  the  public  conscience  may 
eventually  be  stirred. 

3.  Diagnostic  difficulties. 

Our  third  obstacle  is  the  lack  of  a  reliable  or  infalhble 
criterion  of  eugenical  unfitness,  or  of  anyone  competent 


268    MENTAL  HEALTH  OF  SCHOOL  CHILD 

to  pronounce  infallibly  on  all  but  the  obvious  cases.  Who 
is  competent  to  decide  whether  or  not  a  given  individual 
possesses  desirable  or  undesirable  hereditable  determiners? 
Who  is  able  to  say  unequivocally  that  a  given  individual 
is  eugenically  defective  and  that  he  can  only  give  issue  to 
tainted  progeny?  Who  can  determine  with  scientific 
exactness  that  certain  determiners  are  lacking  in  'x'  and 
that  the  same  determiners  are  likewise  lacking  in  his 
intended  consort?  Who  is  able  to  determine  whether  a 
so-called  normal  person  may  not  be  the  carrier  of  defect- 
ive strains,  just  as  healthy  persons  may  be  disease  carriers, 
whereby  unions  between  such  normals  may  be  just  as 
non-eugenical  as  unions  between  obvious  degenerates?  It 
must  be  confessed,  I  believe,  that  the  gaps  in  our  knowl- 
edge of  the  laws  of  human  heredity  from  the  biological 
side  are  still  deplorably  wide.  As  far  as  concerns  the 
psychological  identification  of  mental  defectives,  our 
present  technique  enables  us  to  locate  the  extreme  types, 
but  not  the  borderland  cases.  One  of  our  best  schemes  of 
mental  classification  is  the  Binet-Simon  scale.  But  after 
having  personally  used  this  scale  almost  daily  for  three  or 
four  years  in  the  study  of  the  feeble-minded,  epileptic, 
insane,  juvenile  delinquents  and  backward  children,  I  am 
free  to  confess  that  while  the  great  utility  of  the  scale 
cannot  be  questioned,  it  is  not  by  any  means  the  marvelous, 
unerring  machine  which  it  is  claimed  to  be  by  certain 
overzealous  exploiters,  even  for  the  purpose  merely  of 
measuring  the  degree  of  mental  arrest.  Nevertheless,  with 
improved  measuring  scales  of  intellectual  capacity,  sup- 
plemented by  the  scales  of  personal,  social,  motor-industrial 
and  pedagogical  efficiency  (see  Chapter  VI),  and  by 
developmental  and  heredity  case-studies,  the  difl5culties 
pertaining  to  the  accurate  diagnosis  of  mental  cases  will 


CHILD  ORTHOGENESIS  269 

probably  not  prove  insuperable.  The  establishment  of 
adequate,  reliable  mental  development  scales  is  a  large 
task,  which  cannot  be  done  within  a  reasonable  time  with- 
out liberal  pubHc  or  private  subsidy.  One  of  the  reasons 
for  supporting  such  work  is  the  extreme  feasibility  of 
experimentation  in  heredo-psychology.  In  the  psycho- 
logical field  it  is  easy  to  test  and  experiment  on  fit  as  well 
as  unfit  individuals.  Mobile  in  the  biological  field  human 
heredity  experimentation  is  almost  impossible.  This 
brings  us  to  the  statement  of  the  final  obstacle  confronting 
applied  eugenics,  namely : 

4.     Experimental  difficulties. 

If  it  were  possible  to  apply  the  principles  of  experi- 
mental genetics  to  human  breeding  as  those  principles  are 
now  apphed  to  the  breeding  of  domestic  animals,  many  of 
the  controverted  problems  could  be  brought  to  a  fairly 
expeditious  adjudication.  Just  because  this  seems  impos- 
sible of  achievement,  the  propagandist  must  beware  lest 
he  bring  disrepute  upon  the  eugenics  movement  by  advo- 
cating precipitate,  ill-advised  or  premature  action.  There 
is  danger  that  zeal  may  get  the  better  of  wisdom,  and  that 
state  and  national  laws  may  be  passed  which  we  shall 
later  come  to  rue.  In  the  absence  of  experimental  demon- 
stration, who  shall  say  that  the  laws  of  human  heredity 
are  Mendelian  and  not  Galtonian  in  character.?  What 
warrant  is  there  for  affirming  that  such  socially  significant 
complex  mental  traits  as  honesty,  courage,  virtue,  initia- 
tive, concentration,  perseverance,  intelligence,  judgment, 
reasoning,  kindness  and  loyalty  are  unit  characters  and 
are  transmissible  as  simple  determiners.''  Woods  affiiTns 
that  they  do  not  behave  as  unit  characters  and  are  not 
transmissible  as  such.     But  it  is  just  such  mental  char- 


270    MENTAL  HEALTH  OF  SCHOOL  CHILD 

acters  as  these  that  it  is  im,portant  to  transmit,  for  fun- 
damentally the  difference  between  a  social  fit  and  misfit  is 
a  difference  in  mental  qualities  ;  the  age  of  brute  or  muscu- 
lar force  has  been  superseded  by  the  age  of  intellectual  or 
psychic  force. 

Since  the  important  question,  therefore,  is  to  determine 
whether  socially  significant  complex  human  mental  traits 
are  heritable,  and  since  this  cannot  be  directly  determined 
for  man  by  the  method  of  experimental  genetics,  what  is 
to  be  done?  The  following  brief  outline  of  both  practical 
conservational  and  eugenical  research  work  is  suggested: 

1.  Conservational  bureaus  or  agencies  should  be  estab- 
lished on  a  community  basis,  in  the  cities  and  common- 
wealths, for  the  purpose  of  scientifically  supervising  the 
health,  growth,  hygiene  and  educational  development  of 
the  child  from  birth  to  the  period  of  late  adolescence.  A 
community  plan  of  this  character  has  already  been 
sketched  in  the  earlier  section  of  the  chapter.  I  incline  to 
the  opinion  that  the  work  should  be  organized  in  connec- 
tion with  the  public  school  systems,  not  merely  because  this 
public  agency  is  already  in  existence,  nor  because  it  would 
prevent  the  duplication  of  material  plants,  nor  yet  be- 
cause the  people  have  confidence  in  the  public  school 
systems ;  but  because  I  believe  that  the  integral  function 
of  the  public  schools  is  not  only  instruction  or  training 
but  also  the  conservation  of  the  mental,  moral  and  physi- 
cal health  of  the  children  entrusted  to  their  care. 

2.  One  of  the  specific  functions  of  this  bureau,  or  of 
some  other  organization,  should  be  the  biographical  chart- 
ing of  all  babies  bom  into  the  world,  or  at  least  of  all 
infants    of   presumptively    degenerate    stock. ^      The   bio- 

f>  Mothers  should   be  trained  to  keep  maternal  diaries  of  children 
from  the  time  of  birth. 


CHILD  ORTHOGENESIS  271 

grapliical  charts,  on  which  the  first  entries  should  be 
made  shortly  after  birth,  should  contain  such  facts  as  the 
following:  date,  order,  circumstances,  condition,  weight 
and  height  at  birth;  the  mental,  socio-moral  and  physical 
condition,  eating  and  drinking  habits,  overwork  and  acci- 
dents of  the  mother  before  and  at  the  time  of  birth;  the 
state  of  health,  habits,  etc.,  of  the  father  at  the  time  of 
the  conception;  a  record  of  the  hereditary  factors  in  the 
direct  and  indirect  ancestral  lines ;  a  statement  of  the 
housing  and  environmental  conditions.  Later  entries 
would  indicate  whether  the  child  was  breast  or  bottle  fed, 
and  for  how  long,  whether  he  was  properly  nourished, 
clothed,  disciplined  and  protected  from  moral  and  physical 
injury  during  childhood,  and  contain  a  record  of  his  dis- 
eases, physical  defects,  accidents,  annual  anthropometrical 
indices,  developmental  retardations  or  accelerations,  mental 
and  physical  peculiarities  or  abnormalities.  This  card,  or 
a  duplicate,  should  accompany  the  child  to  school,  where  it 
would  be  properly  filed  and  where  it  would  be  supplemented 
by  annual  entries  made  by  the  teachers,  the  school  nurse 
or  social  worker,  the  school  psychologist  and  physician. 
These  entries  would  show  the  child's  physical  and  mental 
condition,  as  determined  by  anthropometric,  medical  and 
psychological  tests,  and  his  pedagogical  progress  from 
year  to  year.  The  data  thus  secured  (to  be  made  avail- 
able only  to  the  officers  of  instruction,  diagnosticians  and 
research  workers)  would  enable  us  scientifically  to  trace 
pedagogic  facts  and  child  problems  to  their  real  ante- 
cedents, they  would  be  of  value  for  the  intelligent  guid- 
ance, care,  development  and  training  of  the  child,  they 
would  enable  us  to  locate  and  diagnose  more  speedily  and 
effectively  the  social  incompetents,  they  would  contribute 
material  of  great  value  to  the  science  of  human  eugenics, 


272    MENTAL  HEALTH  OF  SCHOOL  CHILD 

and  would  likewise  possess  considerable  value  for  the  guid- 
ance of  the  child  himself  after  he  has  reached  his  majority. 

3.  A  number  of  specific  medical,  psychological,  peda- 
gogical and  anthropometric  investigations,  because  of 
their  practicability  and  the  light  which  they  will  shed  on 
various  eugenical  factors,  should  be  prosecuted  on  a  large 
scale.  For  example:  what  is  the  difference  in  the  rate  of 
mental  and  physical  development  between  children  of  alco- 
holized or  caffeinized  or  narcotized  parents  and  children 
of  abstainers  from  alcohol  and  caffeine  and  tobacco?  If 
there  is  a  difference,  does  it  appear  during  early  childhood, 
during  early  adolescence,  or  later?  Do  the  differences 
gradually  disappear,  so  that  both  classes  of  children 
eventually  reach  their  normal  type,  just  as  some  species  of 
animals  whose  development  has  been  artificially  or  experi- 
mentally retarded  later  recover  their  losses? 

Likewise,  what  is  the  relation  between  narcotized  parent- 
age and  mental  and  physical  defects,  deformities  and 
abnormalities  and  arrested  epiphyseal  development  in  the 
offspring?  To  answer  these  questions  extensive  serial 
ps3'chological,  anthropometric,  physiological  and  radio- 
graphic tests  need  to  be  made  of  children  of  alcoholized 
and  non-alcoholized  parentage. 

A  number  of  studies  already  made  indicate  that  this  is 
a  fruitful  field  for  protracted  research.  Thus  in  some  of 
the  special  classes  in  London  and  Birmingham  40  per  cent 
of  the  pupils  are  reported  as  having  intemperate  parents, 
while  the  corresponding  percentage  for  pupils  of  the  same 
age  in  the  regular  classes  was  only  6  per  cent.  Of  like 
tenor  is  the  reported  fact  that  in  some  cantons  in  France 
the  schools  have  been  flooded  with  an  army  of  laggards 
seven  years  after  good  wine  years. 

In  an  investigation  carried  out  on  the  students  of  Mur- 


CHILD  ORTHOGENESIS  273 

doch  Academy,  In  Utah,  it  appeared  that  the  offspring  of 
non-narco-stimulant  parents  were  superior  to  those  of 
the  stimulant  parents  in  all  of  the  twenty-two  mental  and 
physical  traits  examined ;  that  as  the  amount  of  caffeine 
consumed  daily  was  increased  there  was  observed  a  pro- 
gressive deterioration  in  the  height,  weight  and  bodily 
condition  of  the  offspring;  that  the  mental  and  physical 
inferiority  was  increased  when  the  parents  used  both 
coffee  and  tea,  when  they  used  tobacco  and  particularly 
when  they  used  alcohol  also ;  79  per  cent  of  the  narcotized 
parents  had  lost  one  or  more  infants,  while  only  49  per 
cent  of  the  abstainers  had  suffered  such  losses.  It  required 
from  eight-tenths  to  one  year  longer  for  the  narcotized 
progeny  to  graduate  from  the  grades,  and  their  average 
age  was  one  year  and  seven  months  older  in  the  academy/*' 
A  parallel  study^^  of  the  effects  of  coffee  drinking  by 
children  on  their  oxen  development  enforces  a  conclusion 
pi'eviously  reached,  that  a  sharp  separation  cannot  be 
made  between  the  eugenical  and  euthenical  aspects  of 
various  environmental  factors.  Statistics  were  compiled 
for  464  children  in  two  schools  for  a  period  of  one  month. 
The  drinkers  averaged  from  one  and  one-half  to  four 
pounds  less  in  weight,^"  one-half  to  one  inch  less  in  height, 
three  pounds  less  in  strength  of  grip,  2.3  per  cent  less  in 
conduct  as  concerns  those  who  drank  one  cup  only  per 
day,  and  7.8  per  cent  less  as  concerns  those  who  drank 
four  cups  or  more.     The  rank  in  lessons  was  from  2.6  per 

10  Cf.   J.    E.    Hickman.     Journal   of   Philosophy,   Psychology   and 
Scientific  Methods,  1913,  9:  234. 

11  Charles  Keen  Taylor.     Effects  of  Coffee  Drinking  upon  Chil- 
dren, The  Psychological  Clinic,  June  15,  1912,  p.  56f. 

12  In  order  to  obtain  light  jockeys  the  practice  is  said  to  obtain 
in  England  of  having  boys  indulge  in  liberal  quantities  of  alcohol. 


274    MENTAL  HEALTH  OF  SCHOOL  CHILD 

cent  less,  up  to  29.6  per  cent  less  for  those  who  drank 
four  or  more  cups. 

By  prosecuting  on  an  adequate  scale  standardized 
researches  in  heredo-psychology,  heredo-pedagogy  and 
heredo-biology,  analogous  to  those  to  which  reference  has 
been  made  above,  we  shall  eventually  secure  the  ground- 
work of  facts  needed  by  both  euthenics  and  eugenics  in 
order  that  they  may  attain  the  dignity  of  authentic 
sciences. 


i 


CHAPTER  XIII 

EXPERIMENTAL      ORAL      ORTHOGENICS:     AN 

EXPERIMENTAL  INVESTIGATION  OF  THE 

EFFECTS  OF  DENTAL  TREATMENT  ON 

MENTAL  EFFICIENCY' 

Little  if  any  attempt  has  hitherto  been  made  to  measure 
by  scientific,  objective  means  the  mental  improvement 
resulting  from  the  correction  or  removal  of  the  various 
physical  defects  which  are  now  generally  known  to  afflict 
very  many  school  children.  We  believe  that  adenoids, 
hypertrophied  tonsils,  nasal  obstructions,  defective  ears, 
eyes  and  mouths  interfere  with  normal  mental  functioning, 
but  no  one  has  attempted  to  determine  experimentally  the 
precise  orthogenic  effects  which  should  ensue  from  a 
definite  course  of  combined  prophylactic  and  operative 
treatment. 

In  the  present  chapter  we  shall  give  a  very  brief  sketch 
of  the  results  of  an  attempt  to  determine  by  controlled, 
objective,  mental  measures  the  influence  of  hygienic  and 
operative  dental  treatment  upon  the  intellectual  efficiency 
and  working  capacity  of  a  squad  of  twenty-seven  public 
school  children  in  Marion  School,  Cleveland,  Ohio  (ten  boys 
and  seventeen  girls),  all  of  whom  were  handicapped,  to  a 

1  Read  before  Section  L,  Education,  of  the  American  Association 
for  the  Advancement  of  Science,  Washington,  December  29,  1911. 
Reprinted,  with  alterations,  from  the  Journal  of  Philosophy,  Psy- 
chology and  Scientific  Methods,  1912,  290-298. 


276    MENTAL  HEALTH  OF  SCHOOL  CHILD 

considerable  degree,  with  diseased  dentures  or  gums  and  an 
insanitary  oral  cavity.'  These  children  were  the  recipients 
of  free  dental  treatment  at  the  hands  of  the  Cleveland 
Dental  Society  and  the  National  Dental  Association 
during  the  first  few  months  of  the  experimental  year,  which 
began  in  May,  1910,  and  closed  in  INIay,  1911.  The  treat- 
ment included  not  only  the  carpentry  of  carious  teeth 
(that  is,  the  filling  of  dental  cavities,  the  extraction  of 
decayed  roots,  the  cleaning  of  the  teeth  and  correction 
of  irregularities  and  malocclusion)  and  the  sanitation  of 
the  oral  cavity,  but  it  also  consisted  in  teaching  the  chil- 
dren how  properly  to  brush  their  teeth  after  each  meal 
and  how  to  keep  them  free  from  deposits,  how  to  harden  the 
gums  and  how  to  fletcherize  the  food ;  for  oral  euthenics 
contemplates  not  only  mouth  sanitation  and  the  repair  and 
polishing  of  the  teeth,  but  the  thorough  insalivation  and 
mastication  of  the  food.  Verbal  instruction  and  demon- 
strations relating  to  mouth  hygiene  and  correct  eating 
habits  were  given  by  the  then  chairman  of  the  Oral 
Hygiene  Committee  of  the  National  Dental  Association 
during  two  demonstration  meals  which  were  served  to  the 
experimental  class  at  the  school.  Follow-up  work  was 
done  by  an  employed  nurse,  who  gave  individual  advice  and 
instruction  to  parents  and  pupils,  and  made  it  a  point 
to  ascertain  whether  the  pupils  were  faithfully  following 
the  instructions. 

This  research  was  the  outgrowth  of  the  nation-wide 
school  oral-hygiene  campaign  inaugurated  in  Cleveland 
in  March,  1910,  by  the  National  Dental  Association.  My 
own  connection  with  the  movement  consisted  in  suggesting, 

2  A  more  complete  discussion  of  this  research  appears  in  my 
Experimental  Oral  Euthenics,  The  Dental  Cosmos,  April  and  May, 
1911,  pp.  40 Iff.  and  545 ff. 


ORAL  ORTHOGENICS  277 

contri\'ing  and  giving  (in  person  or  by  proxy)  five  series 
of  psychological  efficiency  tests  at  stated  intervals  during 
the  experimental  year.  These  tests  were  designed  to 
measure  any  improvement  or  increase  which  might  result 
from  the  practice  of  the  oral  hygiene  regimen  sketched 
above,  in  the  power  of  immediate  recall  (immediate  visual 
memory  span),  in  the  capacity  to  form  spontaneous  and 
controlled  associations,  in  the  ability  to  add,  and  in  the 
ability  to  perceive,  attend  and  react  to,  certain  visual 
impressions. 

In  the  memory  test  the  pupils  were  required  to  memorize, 
during  a  period  of  forty-five  seconds,  as  many  figures  as 
possible.  Ten  figures,  each  containing  three  digits,  in 
large  print  on  a  cardboard  were  displayed  before  the 
class.  Exactly  one  minute  was  allowed  for  writing.  This 
test  is  thus  based  on  the  use  of  non-sense  materials  and 
furnishes  a  measure  of  the  capacity  to  memorize  digits. 

In  the  spontaneous  association  test,  the  pupils  were  pro- 
vided with  a  sheet  of  paper  containing  a  column  of  thirty 
simple,  everyday  words.  At  a  given  signal  they  were  told 
to  turn  the  papers  right  side  up  and  write  opposite  each 
word  the  first  word  suggested  by  it,  irrespective  of  whether 
or  not  the  suggested  word  was  logically  connected  with 
the  supplied  antecedent  or  key-word.  The  time  allowed 
was  eighty-five  seconds.  The  number  of  words  written  in 
a  test  like  this  furnishes  an  index  of  the  speed  of  ideating 
or  of  forming  free-word  associates  in  connection  with 
supplied  antecedents — or,  in  other  words,  of  the  speed  of 
thinking. 

To  measure  the  speed  of  forming  controlled  associations 
an  antonym  test  was  employed.  In  this,  the  pupils  were 
supplied  with  a  sheet  containing  a  column  of  twenty-five 
key-words,  opposite  each  of  wliich  they  were  instructed  to 


278    MENTAL  HEALTH  OF  SCHOOL  CHILD 

write  (during  eighty-five  seconds)  only  that  word  which 
has  the  opposite  meaning:  e.g.,  better — worse;  sunrise — • 
sunset.  This  test  requires  intelligent  discrimination  and 
demands  a  higher  degree  of  associational  efficiency  than 
that  required  in  the  previous  test. 

In  the  test  on  the  speed  and  accuracy  of  adding,  the 
pupils  were  supplied  with  a  sheet  containing  thirty-two 
columns  of  figures,  each  column  consisting  of  ten  one-place 
digits.  They  were  told  to  add  as  many  columns  as  possible 
within  the  time  limits  (two  minutes)  without  stopping  to 
re-add  any  of  the  columns.  This  test  gives  a  measure  of 
the  ability  to  form  controlled  numerical  associations. 

In  the  attention-perception  test  (A-test)  a  sheet  was 
provided  containing  twenty-six  lines  of  capital  letters. 
The  letters  were  printed  entirely  promiscuously  instead  of 
in  proper  alphabetical  order.  The  pupils  were  told  to 
start  at  the  left  end  of  the  top  line  and  proceed  to  draw  a 
line  through  as  many  of  the  A's  as  possible  within  the  time 
limits  (100  seconds).  They  were  specially  cautioned  not 
to  skip  any  A's  or  to  cross  out  any  other  letters.  This  test 
gives  a  measure  of  the  speed  and  accuracy  of  perceptual 
discrimination,  of  the  power  of  sustained  attention,  and, 
secondarily,  of  the  speed  and  accuracy  of  manual  reaction. 

These  five  tests  thus  explore  some  of  the  fundamental 
mental  traits  or  capacities.  In  all  tests,  and  in  all  sittings, 
the  pupils  were  uniformly  urged  to  do  their  very  best.  A 
system  of  quantitative  and  of  combined  quantitative  and 
qualitative  scoring  was  worked  out  for  each  test.^ 

In  order  that  tests  of  this  character  may  be  used  as 
measuring  rods  for  gauging  the  increased  functional  effi- 

3  See  reference  on  p.  276,  and  the  instruction  sheets  which  are 
supplied  with  the  complete  set  of  test  blanks  by  C.  H.  Stoelting  Co., 
121  North  Green  Street,  Chicago,  III. 


ORAL  ORTHOGENICS  279 

ciency  resulting  from  a  given  euthenic  or  corrective  factor, 
or  factors,  a  number  of  essential  conditions  must  be 
supplied. 

First,  each  of  the  tests  must  be  constructed  in  sets  or 
series,  so  that  some  of  the  tests  may  be  given  before  the 
treatment  begins,  and  some  during  the  course  of  the 
treatment,  or  after  its  close.  In  this  investigation  each 
test  was  arranged  in  six  sets,  numbered  from  1  to  6.  Tests 
1  and  2  were  given  before  treatment  began.  The  average 
of  these  two  pre-treatment  tests,  therefore,  represents  the 
pupil's  initial  efficiency,  or  his  normal  standard  of  per- 
formance. The  last  four  tests  were  given  during  the 
course  of  the  treatment,  or  after  its  close,  so  that  the 
average  of  these  represents  the  pupil's  terminal  efficiency. 
The  difference  between  the  two  averages  accordingly 
represents  the  gain  (index  of  improvement)  made  during 
the  course  of  the  experimental  year.  Or,  instead  of  taking 
the  average  of  the  last  four  tests  for  the  final  efficiency, 
we  may  substitute  the  average  of  the  last  two.  This  plan 
seems  preferable,  because  the  last  two  tests  were  given 
from  three  to  five  months  after  the  dental  treatment  had 
been  completed  for  all  the  pupils,  while  tests  3  and  4  were 
given  only  one  or  two  months  after  the  beginning  of  the 
treatment  for  more  than  half  of  the  pupils.  Sufficient  time 
had,  therefore,  not  elapsed  to  allow  the  orthogenic  effects 
to  become  operative,  at  least  not  in  maximal  degree,  at  the 
time  of  the  third  and  fourth  tests. 

Second,  the  sets  must  be  so  constructed  that  all  of  the 
successive  tests  in  the  same  set  are  uniformly  difficult, 
although  the  material  must  be  differently  arranged.  That 
is,  tests  number  2,  3,  4,  5  and  6  must  be  of  the  same  diffi- 
culty as  test  number  1.  Manifestly,  if  each  of  the  succes- 
sive tests  diminishes  in  difficulty,  the  increased  efficiency 


280    MENTAL  HEALTH  OF  SCHOOL  CHILD 

shown  is  spurious  or  largely  exaggerated.  Contrariwise, 
if  each  successive  test  increases  in  difficulty,  the  actual 
improvement  will  be  minimized  or  counteracted.  Consider- 
able pains  were  taken  to  make  all  the  tests  of  a  given  set 
equi-difficult.  Elsewhere  evidence  has  been  adduced  to 
show  that  the  tests  were  fairly  uniform  in  difficulty,  while 
the  material  was  differently  arranged  in  every  successive 
test. 

Third,  the  conditions  of  giving  the  tests  must  be 
strictly  uniform  in  all  the  successive  sittings.  These  con- 
ditions refer  to  the  character  of  the  explanations,  the  use 
of  incentives  or  suggestions,  the  constant  putting  forth  of 
maximal  effort  by  the  examinees,  the  withholding  of  assist- 
ance or  fore-knowledge  of  the  test  materials,  the  seating  of 
the  pupils,  the  hour  of  the  day  used  for  testing,  the  time 
allowed  for  the  tests,  and  the  employment  of  uniform  super- 
visory conditions.  Moreover,  the  pupils  must  continue 
their  school  work  in  their  usual  classrooms,*  and  the  school 
work  should  go  on  as  before.  A  scrupulous  attempt  was 
made  in  this  research  to  realize  these  requirements. 

Fourth,  to  place  the  results  upon  a  strictly  comparable 
basis,  a  second  squad  of  untreated  children  should  be  given 
exactly  the  same  tests  under  precisely  the  same  conditions. 
These  children  should  come  from  the  same  social  strata  as 
the  treated  children,  should  approximately  be  of  the  same 
ages  and  suffer  from  the  same  degree  of  physical  handicap. 
By  means  of  the  data  obtained  from  such  an  untreated 
squad  we  should  be  able  to  determine  the  amount  of  im- 
provement which  is  due  to  such  contributing  factors  as 
familiarity,    habituation,    practice    and    natural   develop- 

4  One  of  my  critics  assumes  that  the  pupils  were  schooled  in  a 
'small  class.'  This  assumption  is  entirely  without  foundation.  The 
pupils  remained  in  their  regular  classrooms. 


ORAL  ORTHOGENICS  281 

ment  (merely  growing  older),  and  the  share  which  is  solely 
due  to  the  application  of  the  orthogenic  factor  under  con- 
sideration. Unfortunately  it  was  not  possible  for  me  to 
get  such  a  squad  as  this  organized  during  the  experimental 
year. 

Fifth,  and  finally,  the  factor,  or  factors,  whose  ortho- 
phrenic  influence  is  to  be  measured  must  be  investigated 
under  'controlled  conditions.'  One  must  make  certain  that 
the  factor  is  constantly  operative  in  the  treated  squad, 
and  that  it  is  inoperative  in  the  untreated  squad.  In  this 
investigation  the  oral  hygienic  measures  were  subject  to 
a  fair  degree  of  control.  It  was  the  duty  of  the  employed 
nurse  to  see  that  the  pupils  conformed  strictly  to  the 
requirements. 

What,  now,  do  the  results  show  with  respect  to  the 
influence  of  the  dental  treatment  upon  the  working  effi- 
ciency of  the  pupils?  In  attempting  to  answer  this  main 
question  we  shall  also  refer  briefly  to  a  number  of  acces- 
sory facts  brought  out  in  the  investigation.  One  of  these 
facts  is  the  circumstance  that  while  the  boys  manifested  a 
higher  degree  of  efficiency  than  the  girls  in  all  tests  except 
the  perception  test,  the  indices  of  improvement  were  about 
the  same  for  the  two  sexes,  whence  the  boys'  manifest 
superiority  in  the  efficiency  scores  is  not  paralleled  by  a 
corresponding  superiority  in  the  improvement  indices. 
Similarly,  the  amount  of  improvement  was  about  the  same 
for  the  older  and  younger  pupils,  a  result  not  entirely  in 
accordance  with  expectation,  for  it  is  currently  believed 
that  the  benefits  derived  from  the  correction  of  physical 
defects  are  greater  the  earlier  the  treatment  is  applied. 
This  is  believed  to  be  true  particularly  as  regards  naso- 
pharyngeal obstructions.  But  so  far  as  the  mal-efFects  of 
dental  defects  are  concerned  we  are  unable  to  find  any 


282    MENTAL  HEALTH  OF  SCHOOL  CHILD 

significant  age  differences.  Pupils  between  the  ages  of 
eleven  and  fifteen  appear  to  profit  in  equal  degree,  irre- 
spective of  sex,  from  the  broad  application  of  the  principles 
of  mouth  hygiene. 

On  the  other  hand,  the  individual  differences  between 
the  pupils  in  all  tests  are  significant.  The  differences  are 
quite  as  large  as  the  differences  frequently  brought  to 
light  in  other  psychological  and  pedagogical  experiments 
on  pupils  of  the  same  age  or  school  grade.  Some  pupils 
show  a  high  degree,  others  a  low  degree,  of  proficiency ; 
and  some  pupils  make  marvelous  gains  while  others  gain 
very  little,  or  not  at  all,  or  actually  lose  in  efficiency.  It 
is  therefore  apparent  that  experiments  of  this  sort,  which 
are  based  on  only  a  few  pupils,  are  at  best  only  suggestive, 
and  that  valid  inferences  or  conclusions  must  be  based  on 
the  central  tendencies  or  average  results  of  a  considerable 
number  of  pupils. 

Not  only  do  we  find  these  large  individual  differences  in 
the  efficiency  scores  and  improvement  indices,  but  the  fact 
that  a  pupil  gains  much  in  one  test  does  not  warrant  the 
belief  that  he  will  gain  much  in  all  the  other  tests.  Quite 
the  reverse  may  be  the  case.  Thus  a  list  of  the  five  pupils 
who  made  the  smallest  improvements  in  each  of  the  five 
tests,  was  found  to  contain  nineteen  of  the  twenty-seven 
pupils,  while  the  list  of  the  five  pupils  who  made  the 
greatest  gain  in  each  of  the  five  tests,  included  thirteen 
pupils.  But  not  a  single  pupil  was  enumerated  among  the 
five  poorest  in  all  the  tests,  nor  was  a  single  pupil  enumer- 
ated among  the  five  best  in  all  the  tests.  On  the  other 
hand,  eight  of  the  pupils,  ranking  with  the  five  poorest 
gainers  in  one  test  or  another,  also  ranked  with  the  five 
best  gainers  in  one  test  or  another.  While  two  of  these 
showed  little  improvement  in  two  tests,  they,  nevertheless, 


ORAL  ORTHOGENICS  283 

made  large  gains  in  two  tests.  It  is  thus  apparent  that 
many  pupils  who  gain  little  in  some  tests  may  improve 
remarkably  in  others.  But  it  is  worthy  of  remark  that 
only  one  of  the  three  pupils  who  were  enumerated  among 
the  best  gainers  in  three  or  more  tests  was  included  among 
the  poorest  gainers,  while  none  of  the  three  who  were 
among  the  poorest  in  three  tests  took  rank  with  the  five 
best  in  any  of  the  five  tests,  so  that  there  is  a  certain 
amount  of  correlation  between  the  indices  of  improvement 
in  the  various  tests,  justifying  the  conclusion  that  pupils 
who  improve  very  slowly  in  several  tests  will  not  take  place 
with  the  best  ground-gainers  in  any  of  the  tests.  Such 
pupils  are  probably  suffering  from  general  impairment  or 
marked  retardation.  But  teachers  must  recognize  that  a 
child  who  gains  little  along  one  line  of  mental  activity  may 
be  developing  normally,  or  even  supernormally,  along  other 
lines.  His  capacity  for  development  cannot  be  determined 
from  the  improvement  indices  of  one  trait.  Scientific 
pedagogy  will  make  little  progress  until  this  fact  is  recog- 
nized, so  that  the  educational  activities  may  be  adjusted 
to  meet  individual  developmental  idiosyncrasies. 

Although  there  are  these  individual  differences  the  char- 
acter of  the  central  tendencies  is  unmistakable :  there  is  a 
decided  gain  in  every  test,  and  not  only  are  the  gains 
decidedly  more  frequent  than  the  losses,  but  the  largest 
gains  are  invariably  emphatically  larger  than  the  largest 
losses.  This  may  be  seen  from  the  following  data  for  each 
test,  based  on  the  average  scores  of  tests  1  and  2,  and  the 
averages  of  tests  5  and  6  (see  also  Graphs  V  to  IX). 


Graph  V. 
Memorizing  Three~place  Digits 
Per  cent  of  efficiency. 


h 

7 

r 

i 

^       7 

t       t       ^   " 

X       t 

X      r 

1   7 

J^L 

45 

44 

43 

42 

41 

40 

39 

38 
Sitting  1        2        3        4       5       6      1-2    3-6    1-6 


Graph  VI. 

Spontaneous  Association. 
Per  cent  of  efficiency. 


I 


Sitting 


6     1-2    3-6    1-6 


Graph  VII. 

Addition  of  One-place  Digits. 
Per  cent  of  efficiency. 


^=i=3? 


Sitting 


3        4        5        6    1-2    3-6     1-6 


Graph  VIII. 

Antonym  Test. 

Per  cent  of  efficiency. 


1 


1        2        3        4        5       6      1-2    3-6     1-6 


Graph  IX. 

Cancelling  A^s. 
Per  cent  of  efficiency. 


65 

60 

55    .  - 

/ 

50    , 

y 

d'^ 

/ 

/ 

1 

i.n 

/ 

/ 

T.'i 

/ 

/ 

^n     . 

Sitting- 


6     1-2    3-6    1-6 


Explanation  of  Graphs.  The  score  for  each  test  is 
shown  in  per  cents  along  the  vertical  axis.  The  successive 
sittings  are  indicated  by  the  figures  under  the  horizontal 
line  at  the  bottom.  1—2  is  the  average  of  1  and  2,  3-6  of  3 
to  6,  and  1-6  of  1  to  6.  Sitting  1,  May  31,  1910;  sitting 
2,  June  6 ;  3,  August  31 ;  4,  September  21 ;  5,  May  4, 
1911 ;  and  6,  May  10,  1911,  For  other  graphs  see  Dental 
Cosmos,  1912,  May,  from  wliich  these  curves  are  repro- 
duced. 


288    MENTAL  HEALTH  OF  SCHOOL  CHILD 

MeTnory:  eight  pupils  lost  in  amounts  varying  from 
5  to  15  per  cent,  while  nineteen  gained  in  amounts  varying 
from  0  per  cent  to  116  per  cent.  The  average  gain  for 
all  pupils  amounted  to  19  per  cent. 

Spontaneous  association:  two  pupils  lost,  the  one  18  and 
the  other  43  per  cent,  while  twenty-five  gained  from  2  to 
162  per  cent.  The  average  improvement  amounted  to  42 
per  cent. 

Addition:  one  pupil  suffered  a  loss  of  13  per  cent, 
twenty-six  gained  from  6  to  125  per  cent,  while  the  aver- 
age improvement  was  35  per  cent. 

Associating  antonyms :  all  the  pupils  gained  in  amounts 
varjung  from  33  to  666  per  cent,  the  average  gain  being 
129  per  cent. 

Perception-attention:  all  gained  in  amounts  varying 
from  19  to  101  per  cent,  the  average  improvement  amount- 
ing to  60  per  cent. 

It  is  thus  evident  that  the  gains  varied  considerably  in 
the  different  tests,  and  that  the  largest  improvement 
occurred  in  the  antonym,  attention-perception  and  spon- 
taneous association  tests.  The  average  gain  for  all  tests 
amounted  to  57  per  cent,  truly  a  remarkably  large  gain. 

How  large  a  percentage  of  this  significant  gain  is  due 
solely  to  the  improved  physical  condition  of  the  pupils, 
which  resulted  from  the  treatment  .f'  This  question  does 
not  admit  of  a  categorical  answer  in  the  absence  of  paral- 
lel data  from  an  untreated  squad.  Because  of  the  brevity 
of  the  tests,  the  length  of  the  intervals  between  the  tests 
and  the  counteracting  effect  of  the  growing  monotony 
during  the  successive  sittings,  it  is  improbable  that  the 
practice  effects  were  considerable.  The  improvement 
from  familiarity  would  probably  be  larger,  but,  as  a 
matter  of  fact,  many  lost  instead  of  gained  in  the  second 


ORAL  ORTHOGENICS  289 

test.  The  factor  of  novelty  (in  the  first  test)  apparently 
was  stronger  than  familiarity  (in  the  second  test).  It  is 
certain  that  children  improve  very  little  in  their  academic 
work  from  a  similar  amount  of  practice.  But  if  we 
concede  that  one-half  of  the  gain — and  that  is,  I  believe, 
a  sufficiently  liberal  concession — is  due  to  a  number  of 
extrinsic  factors,  such  as  familiarity,  practice  and  in- 
creased maturity,  the  gain  solely  attributable  to  the 
heightened  mentation  resulting  from  the  physical  improve- 
ment of  the  pupils  would  still  be  very  considerable.  There 
is  corroborative  evidence  to  show  that  there  was  a  general 
improvement  in  the  mental  functioning  of  these  pupils. 
This  evidence  is  supplied  by  the  examination  of  the  peda- 
gogical record  of  scholarship,  attendance  and  deportment. 
Most  of  the  members  of  this  experimental  squad  were 
laggards  and  repeaters,  pedagogically  retarded  in  their 
school  work  from  one  to  four  years,  but  during  the  experi- 
mental year  only  one  pupil  failed  of  promotion,  while  six 
did  thirty-eight  weeks  of  work  in  twenty-four  weeks  and 
one  boy  finished  two  years  of  work  within  the  experimental 
year.  Apparently  the  pupils'  physical  condition  had  been 
so  bettered  that  they  were  able  to  profit  by  the  instruction, 
to  form  habits  from  practice  and  to  improve  mentally  as 
a  result  of  increasing  maturity.  They  were  making 
normal  progress  during  the  experimental  year,  while  many 
had  failed  to  do  so  during  the  preceding  year.  During 
the  preceding  year  many  of  the  pupils  were  quite  irregular 
in  their  attendance  owing  to  toothache,  chronic  weariness, 
bodily  indispositions,  irritability  or  distaste  for  school 
work,  and  five  pupils  were  obliged  to  carry  truancy  cards ; 
but  during  the  experimental  year  the  attendance  was 
materially  improved,  the  cases  of  truancy  entirely  dis- 
appeared, while  certain  boys  considered  formerly  as  incor- 


290    MENTAL  HEALTH  OF  SCHOOL  CHILD 

rigible  now  established  new  records  for  deportment  and 
for  tractability. 

The  improved  physical  and  mental  health  of  many  of 
the  pupils,  which  was  noticed  by  the  teachers,  commented 
on  by  the  parents  and  fully  realized  by  the  pupils,  was  also 
made  manifest  in  a  more  buoyant  spirit,  a  healthier  com- 
plexion and  an  improved  disposition  and  deportment. 

This  experiment,  then,  furnishes  the  first  demonstration 
by  means  of  controlled  serial  experimental  tests,  extend- 
ing throughout  a  calendar  year,  of  the  psycho-orthogenic 
effects  of  the  community  application  of  the  broad  prin- 
ciples of  mouth  hygiene.  The  conclusions  which  follow 
from  the  results  of  the  research  are  of  far-reaching 
importance  to  the  state  and  nation  (see  Chapter  XIV). 


CHAPTER  XIV 

THE  RELATION  OF  ORAL  HYGIENE  TO  EFFI- 
CIENT MENTATION  IN  BACKWARD 
CHILDREN' 

My  interest  in  the  Oral  Hygiene  Movement  springs 
largely  from  my  interest  in  race  amelioration  and  conser- 
vation. There  are  two  fundamental  methods  by  means  of 
which  we  shall  be  able  to  conserve  the  best  interests  of  the 
race:  (1)  by  improved  breeding,  or  eugenical  mating. 
This  is  the  more  important  of  the  two  classes  of  measures, 
but  it  is  likewise  the  more  difficult  to  put  into  practical 
operation.  We  cannot  escape  the  fact  that  there  is  a 
very  wide  chasm  between  theoretical  and  practical  eugen- 
ics. (2)  By  improved  bringing  up,  or  the  efficient  control 
of  euthenical  factors.  Among  these  factors  I  include  not 
only  improved  methods  of  child  training  and  education, 
but  also  improved  hygienic  and  sanitary  nurture  and  cor- 
rective and  remedial  care.  While  the  problem  is  essen- 
tially one  of  prevention  rather  than  one  of  cure,  we  cannot 
blind  ourselves  to  the  existence  of  defects  already  estab- 

1  Substance  of  an  address  delivered  before  the  Academy  of  Science 
and  Art,  Pittsburgh,  Pa.,  February  14,  1913  At  this  meeting  a 
moving  picture  film,  'Toothache,'  was  shown.  This  film  is  being 
exhibited  throughout  the  United  States,  in  the  interest  of  the  Oral 
Hygiene  Movement  which  has  been  inaugurated  by  the  National 
Mouth  Hygiene  Association.  Reprinted  from  The  Child,  London, 
1913,  pp.  27-32,  and  from  Oral  Hygiene,  1913,  pp.  892-897,  with 
eliminations  and  additions. 


292    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

lished,  but  must  make  every  effort  to  correct  or  remove 
these.  Now,  there  is  a  general  conviction  that  the  appli- 
cation of  the  above  two  classes  of  preventive  and  correct- 
ive measures  will  improve  the  biological  capital  of  the  race, 
and  thus  make  for  race  amelioration.  Among  other  things, 
there  are  those  who  believe  that  by  the  removal  of  the 
physical  handicaps  which  afflict  our  children  we  shall  be 
able  to  elevate  not  only  their  health  standard  but  also 
their  mental  standard.  This  is  a  question  in  which  I  have 
taken  a  genuine  interest  for  a  number  of  years.  I  have 
been  particularly  interested  in  obtaining  demonstrated  or 
demonstrable  facts  which  would  either  prove  or  disprove 
the  claim  that  the  removal  of  physical  handicaps  will 
increase  the  mental  efficiency  of  school  children;  for,  fun- 
damentally, in  a  state  of  civilization  we  cannot  hope  to 
fashion  a  higher  type  of  humanity  without  elevating  the 
mental  index  of  childhood — although  not,  to  be  sure,  at  the 
expense  of  the  body — for  success  in  a  state  of  civiHzed 
society  depends  more  on  strength  of  mental  action  than  on 
force  of  muscular  power. 

In  looking  through  the  literature,  however,  I  found 
little  direct  or  incontrovertible  evidence  that  the  mentation 
of  school  children  could  be  elevated  by  correcting  physical 
defects  (I  am  not  now  speaking  of  diseases).  To  this 
general  statement  there  is  one  conspicuous  exception, 
namely,  thyroid  treatment  in  the  case  of  cretins  or  persons 
suffering  from  thyroid  insufficiency.  To  be  sure,  there 
were  numerous  observations — not  to  say  extravagant 
claims — on  record  of  the  marvelous  improvement  made  in 
individual  instances  from  proper  nose,  throat,  eye  and  ear 
treatment,  particularly  of  the  improvement  resulting  from 
the  removal  of  adenoids.  But  this  was  not  what  I  wanted. 
Instead  of  casual  observation  and  opinion,  I  wanted  experi- 


ORAL  HYGIENE  293 

mental  evidence  of  a  quantitative  nature.  But  there  was 
no  such  evidence  available;  no  attempt  had  been  made  to 
measure  by  definite  controlled  objective  tests  the  degree  of 
mental  improvement  resulting  from  the  correction  of  vari- 
ous kinds  of  physical  handicaps.  The  nearest  approach  to 
an  exact  quantitative  investigation  were  the  few  statistical 
studies  made  on  the  relation  between  pedagogical  retarda- 
tion and  physical  defects.  But  these  studies  suffered  from 
serious  defects  of  one  kind  or  another  (see  Chapter  XV). 
The  necessity  therefore  appeared  urgent  to  undertake  an 
experimental  inquiry,  by  which  to  measure  by  controlled 
objective  tests  the  influence  of  the  removal  of  physical 
defects  on  the  working  capacity  of  school  children.  It 
seemed  to  me  that  the  best  point  of  attack  for  such  an 
investigation  was  the  diseased  and  unhygienic  cavity  of  the 
mouth,  for  two  reasons :  first,  because  there  is  no  disease 
of  childhood  which  is  so  prevalent  as  dental  caries,  in  fact 
this  defect  is  so  common  that  it  has  been  appropriately 
called  'the  disease  of  the  people' ;  second,  because,  in 
accordance  with  the  statement  accredited  to  Osier,  'There 
is  not  any  one  single  thing  more  important  in  the  whole 
range  of  hygiene  than  the  hygiene  of  the  mouth.'  Accord- 
ingly, I  suggested  to  the  then  chairman  of  the  Oral 
Hygiene  Committee  of  the  National  Dental  Association 
(Dr.  W.  G.  Ebersole)  that  a  series  of  psychological  tests 
be  carried  out  on  a  squad  of  school  children  suffering  from 
very  bad  conditions  of  the  mouth,  with  a  view  to  arriving 
at  a  definite,  objective,  impersonal  measurement  of  the 
orthophrenic  effects  which  might  be  assumed  to  follow 
proper  dental  treatment  and  mouth  sanitation  (for  the 
description  of  the  experiment  and  discussion  of  the  results 
made  at  this  point  in  the  address,  see  Chapter  XIII). 


294    MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  significant  positive  results  of  this  experiment  sug- 
gest considerations  of  great  practical  moment. 

There  is  no  phase  of  the  entire  modern  child  conserva- 
tion movement  which  merits  deeper  scientific  study  by 
qualified  experts  than  the  relation  between  the  normal 
physical,  mental  and  pedagogical  health,  growth  and 
development  of  school  children  than  a  community  plan  of 
physical  and  mental  orthogenesis.  No  phase  of  the  prob- 
lem of  national  conservation  or  racial  euthenics  more 
nearly  affects  the  very  fundamentals  of  human  existence. 
Our  greatest  national  asset  is  the  normal,  healthy  child — 
the  child  originally  sound  in  body  and  mind  by  virtue  of  a 
rich  hereditary  dower,  or  the  child  rendered  sound  by  the 
removal  of  physical  or  mental  handicaps  through  the 
application  of  the  broad  principles  of  human  physical  and 
mental  orthogenesis.  Instead  of  devoting  their  resources 
to  the  gathering  of  mere  statistics,  to  making  surveys  of 
what  this  community  and  that  city  are  doing  to  better  the 
welfare  of  the  child,  or  to  treating  results  rather  than 
causes,  our  child  conservationists,  eugenic  enthusiasts  and 
welfare  foundations  could  make  a  larger  contribution 
toward  the  permanent  betterment  of  the  race  by  under- 
taking on  an  adequate  scale  genuine  scientific  investiga- 
tions of  the  physiological,  psychological,  hereditary  and 
sociological  causes  of  bodily  and  mental  disability  and 
inefficiency,  and  of  the  demonstrable  effects  of  the  broad 
application  of  orthophrenic  and  orthosomatic  measures. 
The  largest  contribution  to  the  permanent  betterment  of 
the  race  will  be  made  by  those  workers  who  will  undertake, 
on  an  adequate  scale,  genuine,  scientific  investigations  into 
the  actual,  demonstrated  effects  of  the  application  of 
various  orthogenic  measures  of  a  physical  and  mental 
character.      No   such  investigations   are   anywhere   being 


ORAL  HYGIENE  295 

prosecuted  on  an  effective  basis,  notwithstanding  that  no 
one  knows  the  actual,  proven  effects  on  the  child  of  the 
apphcation  of  various  physical  and  psychological  ortho- 
genic measures  or  various  pedagogical  methods  and 
devices.  Our  knowledge  in  this  field  is  largely  pretense 
and  illusion.  In  no  field  of  organized  modern  enterprise 
has  there  been  such  a  lame  attempt  made  to  measure 
results  scientifically  as  in  education.  Indeed,  we  do  not 
as  yet  so  much  as  possess  any  strictly  reliable  scientific 
measures  of  educational  results :  the  very  conception  of 
'measuring  results  in  education'  is  a  product  of  very  recent 
industrial  thinking.  Is  it  not  time  that  our  large  research 
foundations  begin  to  treat  more  fairly  the  problems  of 
human  conservation  and  particularly  those  of  child  ortho- 
genics.'' A  million  dollars  spent  in  orthogenic  investiga- 
tions— in  the  discovery  of  the  psychological,  dento- 
medical,  social,  hereditary,  pedagogical  and  anthropo- 
metric factors  of  deviate  development  in  children  and  in 
the  ascertainment  of  corrective  measures — will  accom- 
plish immeasurably  more  for  the  welfare  of  the  human 
race  than  tens  of  millions  devoted  to  the  cataloguing  of 
the  stars  of  the  heavens  or  exploring  the  trackless  wastes 
of  the  polar  regions. 

The  results  at  which  we  have  arrived  in  this  experiment 
by  controlled  objective  quantitative  methods  emphasize 
anew  the  paramount  importance  of  teaching  the  pupils  in 
our  schools  proper  dental  prophylaxis,  and  of  establishing 
dental  chnics  and  dispensaries,  and  supplying  free  dental 
treatment. in  the  schools  to  all  certified  indigent  cases. 
But  it  should  be  specially  emphasized  that,  owing  to  the 
enormous  number  of  children  suffering  from  diseased  teeth, 
it  is  not  sufficient  merely  to  establish  school  dental  clinics. 
There  are  not  enough  dentists  in  any  community  to  treat 


296    MENTAL  HEALTH  OF  SCHOOL  CHILD 

the  teeth  of  all  the  children  who  have  oral  defects.  It  is, 
therefore,  imperatively  necessary  that  the  work  of  dental 
hygiene  be  so  organized  on  a  community  basis  that  chil- 
dren may  be  systematically  taught  to  care  for  their  teeth 
and  sanitate  their  mouths  from  the  day  that,  as  members 
of  the  schools,  they  become  wards  of  the  state  or  of  the 
community. 

Among  the  fruits  wliich  would  accrue  from  the  introduc- 
tion of  mouth  hygiene  instruction  and  the  estabhshment  of 
dental  clinics  in  the  schools  may  be  mentioned  the  follow- 
ing: (1)  Value  to  the  afflicted  pupils  themselves.  Dental 
hygiene  furnishes  a  means  of  ridding  the  suiFering  pupil 
from  the  exciting  cause  of  pain,  disease,  mental  stagnation, 
moral  deviation  and  irregular  school  attendance.  It  is 
one  of  the  effective  means  available  for  raising  the  child's 
actual  efficiency  a  httle  nearer  to  its  maximal  potential. 
Dental  hygiene  is  a  godsend  to  the  individual  child.  The 
free  dental  school  clinic  must  appeal  to  all  lovers  of  chil- 
dren on  humanitarian  grounds.  (2)  Benefits  to  the  school 
system.  Dental  hygiene  is  one  of  a  number  of  effective 
means  of  combating  the  evils  of  pedagogical  retardation, 
repetition,  elimination,  non-attendance  and  delinquency. 
It  is  a  practical  means  of  increasing  the  efficiency  of  the 
school  system.  It  should  appeal  to  the  teacher,  school 
administrator  and  school  efficiency  engineer.  (3)  Finan- 
cial value  to  the  taxpayers.  The  greater  the  return  on  the 
investment,  the  cheaper  will  be  the  cost  of  maintaining  the 
schools ;  and  obviously,  the  more  proficient  the  pupils  are 
made,  the  greater  will  be  the  returns  on  the  investment. 
The  provision  of  free  dental  inspection  and  treatment  for 
indigent  pupils  is  an  economic  measure  of  the  first  magni- 
tude. In  terms  of  dollars  and  cents,  the  annual  saving  in 
any  school  system  would  amount  to  a  very  considerable 


ORAL  HYGIENE  297 

sum.  For  example,  let  us  assume  that  those  pupils  who 
suffer  from  the  very  worst  mouth  conditions  would  improve 
only  15  per  cent  in  working  efficiency  as  a  result  of  the 
application  of  a  judicious  system  of  mouth  hygiene.  This 
is  a  very  conservative  estimate ;  the  improvement  would 
probably  be  nearer  25  per  cent.  Now  let  us  assume  that 
at  least  20  per  cent  of  the  65,000  pupils  enrolled  in  the 
elementary  public  schools  of  Pittsburgh  suffer  from  very 
bad  oral  conditions,  and  that  these  pupils  are  in  such 
impoverished  circumstances  financially  that  they  would 
not  obtain  any  dental  treatment  unless  school  clinics  were 
established.  The  approximate  cost  of  instriLction  for  the 
elementary  pupils  in  the  public  schools  of  Pittsburgh 
amounts  to  $30  per  year,  therefore  if  each  of  these  13,000 
pupils  gained  15  per  cent  in  working  efficiency  as  a  result 
of  dental  treatment  there  would  accrue  a  saving  of  $4.50 
per  year  for  each  one  of  these  pupils,  or  $58,500  a  year 
for  these  13,000  cases.  This  estimate,  however,  probably 
fails  to  do  full  justice  to  the  benefits  to  be  derived,  because 
it  is  an  undoubted  fact  that  a  very  large  number  of  this 
group  of  children  who  suffer  from  very  bad  dental  condi- 
tions would  fail  in  their  school  work,  and  thus  have  to  be 
educated  at  least  twice  in  the  same  grade.  That  would 
mean  an  additional  cost  of  $30  per  year  for  every  repeater. 
Dental  treatment  would  save  very  many  of  these  cases 
from  failure  to  make  their  grade,  and  thus  save  the  cost 
of  repetition  to  the  taxpayer.  According  to  the  best 
estimates,  it  costs  the  country  $27,000,000  annually  to 
educate  every  sixth  child  two  or  three  times  in  the  same 
grade.  That  part  of  this  enormous  waste  which  is  ascrib- 
able  to  the  presence  of  those  remediable  physical  defects  in 
the  children  which  exert  a  retarding  influence  upon  the 
mental  processes  or  which  cause  children  to  stay  away  from 


298    MENTAL  HEALTH  OF  SCHOOL  CHILD 

school  is  entirely  preventable.  (4)  Benefits  accruing  to 
race  conservation.  Dental  hygiene  will  improve  the  mental 
and  physical  health  of  the  individual  child,  and  this,  in  time, 
will  lay  the  basis  not  only  for  a  more  efficient  citizenship 
but  also  for  a  more  efficient  parenthood;  for  by  elevating 
the  health  index  of  children  we  shall  not  only  increase  the 
health,  happiness  and  productive  capacity  of  adults  but 
also  elevate  the  genesic  or  reproductive  index  of  the  race. 
The  appHcation  of  the  best  euthenical  principles  of  race 
amelioration  will  probably  also  produce  the  highest  eugeni- 
cal  results.  This  argument  is  perhaps  one  of  the  strongest 
arguments  for  developing  community  plans  of  child  ortho- 
genesis. Our  most  sacred  duty  is  to  the  race,  to  posterity. 
Most  of  what  we  have  we  owe  to  our  ancestry,  and  the  best 
that  we  possess  we  should  strive  to  bequeath  to  our  pos- 
terity ;  and  the  most  precious  gift  which  we  can  bestow 
upon  posterity  is  a  normal,  healthy  progeny  and  an 
uncontaminated  heredity. 

Is  it  worth  while  to  attempt  to  save  the  enormous 
annual  waste  in  the  schools  due  to  the  defective  mouths  of 
the  pupils  ?  Is  it  worth  while  to  the  taxpayer  to  eliminate, 
so  far  as  possible,  the  necessity  for  the  extra  financial 
burden  which  he  must  assume  for  instruction  that  should 
have  been  done  satisfactorily  the  first  time.''  Is  it  worth 
anything  to  the  child  to  enable  him  to  attend  school  more 
regularly  and  thereby  increase  his  chances  of  promotion  .^^ 
Is  it  worth  while  to  the  repeater  to  shorten  his  stay  in  the 
schools .?  Is  it  worth  while  to  enable  him  to  attain  a  higher 
level  of  academic  efficiency.''  Is  it  worth  while  to  remove 
physical  obstacles  which  may  lessen  his  efficiency  for  life? 
There  can  be  none  but  an  affirmative  answer.  One  of  the 
means  for  accomplishing  these  desirable  results  appears 
to  be  the  establishment  of  departments  of  orthogenics  in 


ORAL  HYGIENE  299 

the  public  schools.  But  these  departments  must  be  given 
a  broader  scope  than  are  the  present  departments  of  medi- 
cal inspection,  and  must  be  under  the  skilled  direction  of 
health  officers  who  are  experts  in  educational,  child  and 
clinical  psychology,  corrective  pedagogy  and  preventive 
and  corrective  hygiene.  One  division  of  these  departments, 
'orthosomatics,'  should  include  dental  dispensaries. 


CHAPTER  XV 

METHODS    OF    MEASURING    THE    ORTHO- 
PHRENIC  EFFECTS  OF  THE  REMOVAL 
OF  PHYSICAL  HANDICAPS' 

The  conviction  that  there  is  an  intimate  relationship 
between  physical  defectiveness  and  mental  inefficiency  or 
irresponsibility  has  become  an  accepted  postulate  of  cur- 
rent educational,  psychological,  medical  and  criminolog- 
ical thought.  But  for  the  most  part,  this  belief  has  been 
based  on  mere  opinion,  or  favorable  chance  observations. 
It  is  only  within  recent  times  that  any  attempt  has  been 
made  accurately  or  scientifically  to  evaluate  the  physical 
or  mental  influences  of  physical  defects.  And  'yet,  our 
whole  system  of  pupil  inspection,  whether  medical,  dental 
or  psychological,  must  ultimately  justify  itself  to  the 
taxpayer  by  its  demonstrated  orthogenic  results.  The 
taxpayers  have  a  right  to  know  whether  their  systems  of 
school  medical,  dental  and  psycho-educational  inspection, 
clinics  and  dispensaries  represent  a  paying  investment. 
In  a  matter  which  assumedly  so  vitally  concerns  the  con- 
servation of  our  racial  vigor,  we  cannot  aff'ord  to  rest  our 
case  upon  the  verdict  of  assumption,  opinion,  uncritical 
thought,  a  priori  argument  or  on  the  unaided  and  favor- 
able   chance    observations    of    physicians    and    teachers. 

1  An  address  delivered  at  the  third  annual  conference  of  the  Na- 
tional Association  for  the  Study  and  Education  of  Exceptional 
Children,  New  York,  November,  1912. 


PHYSICAL  HANDICAPS  301 

Either  physical  defects  do  or  they  do  not  have  a  deter- 
minate retarding,  deflecting  or  disharmonizing  effect  upon 
the  physical  and  mental  health,  growth  and  development 
of  the  average  child.  If  they  do,  this  fact  must  be  amen- 
able to  demonstration  by  the  methods  of  modem  science. 
The  scientist  rightly  insists  that  the  fields  of  physical  and 
mental  orthogenesis  (orthosomatics  and  orthophrenics) 
must  be  subjected  to  exactly  the  same  kind  of  investigation 
by  verifiable,  demonstrable,  objective  measures  and  the 
same  critical  scrutiny  as  any  other  field  of  modern  inquiry. 

In  the  present  paper  I  shall  attempt  a  brief  survey  of 
the  six  methods  which  have  been  employed  to  measure 
quantitatively  the  influence  of  physical  defects  on  mental 
or  pedagogical  efl'iciency,  and  shall  also  very  briefly 
resume  and  evaluate  the  findings  with  each  method. 

1.  Computations  have  been  made  of  the  comparative 
per  cent  of  pedagogical  proficiency,  in  terms  of  average 
scholarship  rating,  attained  by  groups  of  physically 
defective  and  physically  normal  children.  The  compari- 
son is  based  on  the  assumption  that  if  physical  defects 
exert  a  retarding  influence  the  physically  defective  groups 
should  rank  lower  in  scholarship. 

Of  219  boys  and  girls  ranging  from  six  to  twelve  years 
of  age  examined  in  one  school  in  Philadelphia  in  1908,  it 
was  found  that  the  average  grade  attained  was  75 
per  cent  for  'normal  children,'  74  per  cent  for  'average 
children,'  72.6  per  cent  for  'general  defectives,"  and  72 
per  cent  for  pupils  who  had  adenoids  and  enlarged  tonsils 
(Cornell,  Psychological  Clinic,  January,  1908).  While 
the  diff*erence  between  the  extreme  groups  amounts  to  only 
3  per  cent,  the  physically  normal  pupils,  at  any  rate, 
rank  slightly  higher  in  scholarship  than  groups  of  physical 
defectives. 


302    MENTAL  HEALTH  OF  SCHOOL  CHILD 

This  method  is  subject  to  the  criticism  that  it  deals  to 
some  extent  with  an  abstraction.  The  strictly  physically 
normal  child  is  largely  a  myth.  This  method,  therefore, 
only  enables  us  to  compare  the  scholarship  of  children 
relatively  free  from  physical  defects  with  children  quite 
obviously  handicapped. 

2.  Enumerations  have  been  made  of  the  average  num- 
ber of  physically  defective  pupils  found  in  groups  of 
pedagogically  or  mentally  defective,  retarded,  normal  and 
supernormal  pupils.  Here,  again  (because  the  method  is 
just  the  obverse  of  the  preceding),  the  argument  is  simi- 
lar :  if  physical  defects  reduce  the  cliild's  working  efficiency 
or  impair  his  mentality  we  should  find  more  physical 
defects  among  the  feeble-minded,  backward  and  dull,  than 
among  the  on-time,  or  the  bright  pupils.  A  number  of 
investigations  have  approached  the  question  from  this 
point  of  view. 

In  Halle,  it  was  found  that  only  26  per  cent  (or  fifty- 
seven  cases)  of  the  215  pupils  (assumedly  feeble-minded) 
enrolled  in  the  auxihary  classes  in  1901  were  free  from 
physical  defects  (exclusive  of  trivial  disorders),  while  in 
1903-1904  only  12  per  cent  of  the  209  enrolled  were  in 
'perfect  condition.'  Unfortunately  no  comparative  data 
for  pedagogically  normal  children  are  given. 

A  study  of  137  entrants  in  the  schools  of  Princeton,  HI., 
in  1901-1902  showed  that  those  retarded  only  one  year 
had  no  physical  defects,  while  all  of  those  retarded  three 
years  or  more  were  defective  (Gayler). 

In  Jeff^erson  City,  Mo.,  37  per  cent  of  the  pupils  inves- 
tigated who  had  defective  eyes  did  unsatisfactory  work, 
while  only  26  per  cent  of  those  who  had  good  eyes  did 
unsatisfactory  work. 

In   Los   Angeles,   only   16   per  cent   of  fifty   markedly 


PHYSICAL  HANDICAPS  303 

bright  pupils  were  found  physically  defective,  as  against 
86  per  cent  of  fifty  dull  pupils. 

In  the  schools  of  Camden,  N.  J.,  8,110  on-time  and 
2,020  retarded  pupils  were  given  a  physical  examination 
in  1906.  The  percentages  of  defective  vision  and  hearing 
were  for  the  on-time  (or  normal-age)  pupils  27.1  per  cent 
and  3.7  per  cent,  respectively,  while  the  corresponding 
figures  for  the  retarded  group  amounted  to  28.9  per  cent 
and  5.8  per  cent,  a  difference  of  merely  1.8  per  cent  and 
2.1  per  cent  respectivel3^  A  special  inquiry  into  the 
causal  factors  of  the  failure  of  the  2,020  retardates  also 
indicated  that  physical  defects  were  of  minor  importance. 
The  causes  were  ranked  as  follows:  late  entrance,  21.2 
per  cent ;  slowness,  21  per  cent ;  absence,  28.5  per  cent ; 
dullness,  12  per  cent ;  ill  health,  9.6  per  cent ;  defects  other 
than  visual  and  auditory,  3.9  per  cent,  and  mental  weak- 
ness, 3.7  per  cent  (Bryan).  A  reexamination  of  1,279 
on-time  and  573  retarded  pupils,  who  failed  of  promotion, 
gave  the  following  results : 

On-time  Retarded  Difference 

Per  cent  Per  cent  Per  cent 

Defective  vision    51  40  — 11 

Defective   hearing    14  11  —  3 

Bad  health    21  21  0 

Irregular  attendance    30  40  10 

Curiously,  the  normal-progress  pupils  were  more  defective 
than  the  retardates. 

But  among  203  Cleveland,  Ohio,  school  cliildren  which 
were  investigated,  it  was  found  that  onl}'^  63  per  cent  with 
a  scholarship  mark  of  'very  good'  had  physical  defects,  as 
against  73.1  per  cent  of  those  marked  'good,'  71.1  per  cent 
of  those  marked  'fair'  and  86.6  per  cent  of  those  marked 
'poor.' 


304    MENTAL  HEALTH  OF  SCHOOL  CHILD 

In  Philadelphia,  physical  examinations  have  been  made 
of  so-called  'exempt'  and  'non-exempt'  pupils.  Exempt 
pupils  include  those  who  are  advanced  to  a  higher  grade 
without  examination,  by  virtue  of  superior  attainments. 
Of  907  exempt  pupils  examined  in  five  schools  only  28.8 
per  cent  were  defective,  as  against  38.1  of  687  non-exempt 
(Cornell).  In  another  group  consisting  of  3,587  exempt 
and  1,418  non-exempt  pupils,  only  49  per  cent  of  the 
exempt  were  defective,  as  against  65  per  cent  of  the 
non-exempt.  The  differences  amounted  to  0  per  cent  for 
defective  vision,  2  per  cent  for  defective  hearing,  .6  per 
cent  for  nose  defects,  — .1  per  cent  for  throat  defects, 
1.1  per  cent  for  orthopedic  defects,  5.5  per  cent  for  mental 
defects,  4  per  cent  for  skin  diseases  and  3  per  cent  for 
miscellaneous  defects  (Newmayer).  Singularly,  the  dif- 
ference is  considerable  for  certain  defects  which  should 
have  little  bearing  on  mental  efficiency,  while  it  is  negli- 
gible for  those  defects  which  are  considered  to  impair 
mental  action. 

Another  investigation  in  Philadelphia  showed  that  in  the 
general  school  population  the  percentage  of  physically 
normal  pupils  was  38  per  cent,  while  in  a  primary 
school  for  dull  pupils  (William  McKinley)  it  was  only 
half  as  large,  or  19  per  cent,  and  in  classes  for  the  high- 
grade  or  feeble-minded  it  was  still  less,  or  12  per  cent. 
This  study  no  doubt  also  includes  defects  which  can  have 
little  bearing  on  mentality ;  but  it  is  significant  that  there 
were  only  28  per  cent  of  eye  defects  in  the  general  school 
population,  as  against  80  per  cent,  39.4  per  cent  and  42 
per  cent,  respectively,  in  two  schools  for  retardates  and 
in  the  classes  for  the  feeble-minded.  Again,  in  one  school 
the  percentages  of  nose  and  throat  defects  in  two  bright 
classes  were  12  per  cent  and  10.2  per  cent,  respectively. 


PHYSICAL  HANDICAPS  305 

while  in  two  of  the  dullest  sixth  and  seventh  grades  the 
figures  were  28.1  per  cent  and  31  per  cent,  respectively 
(Cornell). 

On  the  other  hand,  if  we  turn  to  an  investigation  made 
in  New  York  City  embracing  7,608  pupils  in  the  eight 
elementary  grades,  6,084  of  whom  were  on-time  and  1,524 
retarded,  we  find,  curiously,  that  the  percentage  of  physi- 
cal handicaps  was  actually  4.9  per  cent  greater  for  the  on- 
time  than  for  the  retarded  group  (79.8  per  cent  vs.  74.9 
per  cent:  Ayres).  Another  investigation  of  3,304  New 
York  pupils  ranging  from  ten  to  fourteen  years  of  age 
seems  to  explain  the  curious  discrepancies  found  in 
New  York  City  and  Camden.  It  indicated  that  compari- 
sons in  respect  to  physical  defectiveness  between  over-age 
retarded  and  on-time  normal  children  may  be  quite  worth- 
less, because  of  discrepancy  in  the  age  of  the  pupils.  It 
was  found  that  a  marked  decrease  in  the  prevalence  of 
some  defects  begins  at  eight,  nine  and  ten,  and  that  if  the 
younger  children  are  excluded  from  the  study,  a  positive 
correlation  exists  between  physical  defects  and  the  peda- 
gogical rating.  This  may  be  seen  from  the  following 
per  cents  of  various  defects  among  bright,  normal  and 
dull  pupils : 

Defect  Bright  Normal  Dull 

Enlarged   glands    6  13  20 

Defective  vision   29  25  24 

Defective  breathing 9  11  15 

Defective    teeth    34  40  42 

Hypertrophied  tonsils    12  19  26 

Adenoids    6  10  15 

Other  defects    11  11  21 

Per  cent  defective 68  73  75 


306    MENTAL  HEALTH  OF  SCHOOL  CHILD 

It  is  noteworthy  that  the  largest  differences  are  for  defect- 
ive teeth,  defective  breathing,  adenoids  and  enlarged 
tonsils. 

In  Elmira,  N.  Y.,  an  investigation  of  repeaters  in  the 
second  grade  showed  that  21  per  cent  of  those  who 
required  three  years,  and  40  per  cent  of  those  who  required 
four  years  to  complete  the  grade  had  adenoids,  as  against 
only  19  per  cent  of  those  who  required  only  two  years  to 
do  the  grade.  Seventeen  per  cent  and  27  per  cent,  respect- 
ively, of  those  who  spent  three  and  four  years  in  the  grade 
suffered  from  anemia,  as  against  15  per  cent  for  those 
who  required  two  years.  The  corresponding  figures  for 
defective  vision  are  24  per  cent  and  26  per  cent,  as 
against  21  per  cent.  Here  there  is  a  consistent  positive 
correlation. 

In  1907,  a  special  study  was  made  of  1,000  of  the  Cam- 
den repeaters  (Heilman).  The  pupils  were  divided  into 
five  groups  according  as  they  were  retarded  from  one  to 
five  years,  and  the  percentage  of  pupils  in  each  group 
having  physical  defects  was  computed.  The  correlation 
between  pedagogical  retardation  and  the  percentage  of 
physically  defective  children  is  given  for  the  various 
defects  in  the  following  tabulation: 


1  year 

Defects  Per  cent 

Health    16.5 

Nutrition    13.4 

Adenoids     6.2 

Speech    6.2 

Visual  defects    ....  15.5 

Auditory  defects    .  .  8.2 


Retardation 

2  years 

3  years 

4  years 

5  years 

Per  cent 

Per  cent 

Per  cent 

Per  cent 

21.3 

28.0 

19.0 

37.5 

8.9 

17.2 

20.2 

17.5 

7.3 

8.1 

9.6 

7.5 

5.1 

4.2 

10.5 

20.0 

15.9 

18.2 

22.8 

22.8 

6.7 

4.9 

6.1 

10.0 

PHYSICAL  HANDICAPS  307 

Here    there    is    a    fairly    good,    although    not    uniformly 
consistent,  positive  correlation. 

In  spite  of  the  discrepancies  which  we  have  found  in  the 
review  of  this  method,  the  results,  in  the  main,  point  to  a 
positive  correlation  between  physical  defectiveness  and 
pedagogical  retardation.  But  the  method  itself,  however 
valuable,  is  subject  to  various  shortcomings.  As  usually 
applied,  no  cognizance  is  taken  of  differences  of  age,  social 
and  economic  status,  differences  in  the  environment  and 
other  factors  which  are  believed  to  influence  both  retarda- 
tion (and  acceleration  )and  physical  defectiveness.  For 
example,  as  already  indicated,  certain  physical  defects 
increase  with  age  {viz.,  the  visual,  spinal  and  nervous), 
while  others  decrease  {viz.,  the  nasopharyngeal,  auditory 
and  dental).  It  is  therefore  evident  that  without  a  rigid 
control  of  conditions  the  results  may  be  entirely  mislead- 
ing. Moreover,  both  the  physical  defects  and  the  mental 
torpor  may  be  merely  symptoms  of  an  underlying  factor 
which  is  their  common  cause.  They  may  not  be  inde- 
pendent variables,  or  even  variables  dependent  upon  each 
other,  but  both  may  be  dependent  upon  a  third  factor  or 
set  of  factors. 

3.  The  average  number  of  physical  defects  per  child 
has  been  ascertained  for  groups  of  pedagogically  re- 
tarded, on-time  and  accelerated  pupils.  This  method 
differs  from  the  preceding  only  in  that  instead  of  finding 
the  per  cent  of  defective  pupils  in  the  different  peda- 
gogical groups  the  average  number  of  defects  per  cliild  is 
found.  It  is,  again,  assumed  that  if  there  is  any  causal 
relation  between  physical  defects  and  pedagogical  stagna- 
tion, the  more  numerous  the  defects  the  greater  will  be  the 
retardation  in  any  given  case. 

Investigations   made   in    Cliicago    from    1903   to    1905 


308    MENTAL  HEALTH  OF  SCHOOL  CHILD 

showed  that  1,600  boys  in  the  regular  grades  had  an 
average  each  of  4.6  to  5.3  of  growth  defects  (these 
'growth'  are  not  synonymous  with  the  so-called  physical 
defects),  while  the  corresponding  number  of  'motor' 
defects  ranged  from  2.9  to  4.3  per  child.  But  in  the 
parental  school,  in  which  most  of  the  boys  were  peda- 
gogically  retarded  from  one  to  five  years,  the  number  of 
growth  defects  averaged  from  6.8  to  7.3,  and  the  number 
of  motor  defects  from  5.2  to  6.1.  The  deficiency  for  the 
parental  school  boys  averaged  about  25  per  cent  higher 
than  for  boys  hailing  from  the  better  sections  of  the  city. 
Not  only  were  the  defects  among  the  disciplinary  cases 
more  numerous  but  they  were  more  pronounced  in  severity 
(Bruner,  1906). 

In  the  New  York  investigation,  based  on  3,304  cases, 
to  which  reference  has  already  been  made,  the  average 
number  of  defects  for  bright  children  was  1.07;  for 
normal  children,  1.30;  and  for  dull  children,  1.65,  an 
appreciable  difference  as  between  the  bright  and  dull. 

The  average  number  of  physical  defects  per  child  for 
the  1,000  Camden  repeaters,  already  mentioned,  was  as 
follows  for  the  groups  retarded  one,  two,  three,  four  and 
five  (or  more)  years:  .65,  .65,  .82,  .89  and  1.20  (Heil- 
man).  Here  there  is  a  fairly  consistent  increase  in  the 
number  of  defects  with  each  increasing  year  of  retardation. 

This  method  possesses  the  same  virtues  and  the  same 
defects  as  the  preceding  method.  The  results  may  be 
vitiated  by  the  inclusion  in  the  averages  of  physical  defects 
which  have  no  relation  to  intelligence,  although  they  may 
multiply  with  increasing  retardation,  and  by  the  fact  that 
the  physical  defects  may  be  no  more  truly  causative  of  the 
mental  deficiency  than  the  mental  deficiency  is  causative 


PHYSICAL  HANDICAPS  309 

of  the  physical  defects,  because  both  may  be  only  symptoms 
of  an  underlying  lack  of  biological  capital. 

4.  Pupils  may  be  classified  on  the  basis  of  psycho- 
logical tests  of  certain  mental  traits,  into  subnormal, 
normal  and  supernormal  groups,  and  after  being  so  classi- 
fied the  average  number  of  physical  defects  per  child,  or 
the  percentage  of  physically  defective  children  in  each 
group,  may  be  ascertained.  This  method  has  elements  in 
common  with  all  the  preceding  methods,  but  the  difference 
is  that  the  pupil's  mental  status  is  determined  by  objective, 
controlled  psychological  tests  rather  than  by  the  mere 
judgment  of  the  teacher  or  by  the  less  accurate  pedagogi- 
cal tests.  Here  the  attempt  may  be  made  not  only  to 
determine  the  inherent  strength  of  various  mental  traits, 
such  as  memory,  imitation,  perception,  association,  atten- 
tion or  reasoning,  but  also  the  relation  of  specific  mental 
defects  to  specific  physical  defects. 

No  satisfactory  studies  of  this  type  have  been  made. 
Two  studies  from  the  Chicago  public  schools  may,  however, 
be  referred  to  in  this  connection.  In  1900-1901  a  study 
was  made  of  the  relation  between  deficiency  in  visual  and 
auditory  memory  and  subnormal  visual  and  auditory 
acuity.  A  slight  positive  correlation  was  found.  Of  those 
who  were  superior  to  the  average  in  auditory  memory,  32 
per  cent  had  visual  and  10  per  cent  had  auditory  defects; 
while  the  corresponding  per  cents  for  those  who  were 
inferior  to  the  average  were  41  per  cent  and  14  per  cent. 
Of  those  superior  to  the  average  in  visual  memory,  32  per 
cent  had  visual  and  10  per  cent  hearing  defects ;  while  for 
those  inferior  in  visual  memory  the  figures  were  45  per 
cent  and  15  per  cent  (Smedley). 

In  1904-1905  a  study  was  made  of  256  dehnquent  boys 
in  the  parental  school.    The  teachers  made  a  careful  study 


310    MENTAL  HEALTH  OF  SCHOOL  CHILD 

of  the  memory,  reasoning  and  attention  capacities  of  the 
pupils  (but  presumably  not  by  controlled  tests),  and 
special  investigators  examined  the  boys  for  defects  in 
growth,  particularly  for  cranial  anomalies,  A  corre- 
spondence between  the  physical  and  mental  conditions  was 
found  in  77.5  per  cent  of  the  cases,  and  no  correspondence 
in  22.5  per  cent.  The  'bright'  pupils  had  less  defects  than 
the  normal,  the  'fair'  about  the  average  number,  and  the 
'poor'  were  decidedly  below  par. 

It  is  regrettable  that  so  little  use  has  been  made  of  this 
method,  for  there  can  be  no  doubt  that  valuable  data  for 
the  scientific  solution  of  our  problem  may  be  obtained  by 
the  application  of  mental  tests,  provided  proper  care  be 
taken  in  the  selection  and  control  of  the  tests  and  in  the 
selection  of  the  control  subjects. 

5.  The  rate  of  progress  through  the  elementary 
grades  has  been  ascertained  for  groups  of  pupils  suffering 
from  various  physical  defects  and  for  groups  free  from 
physical  defects.  How  much  longer  does  it  take  physi- 
cally defective  pupils  to  complete  the  eight  elementary 
grades  than  physically  normal  pupils.''  What  is  the  dif- 
ference in  the  retarding  influence  of  various  kinds  of 
physical  defects.''  How  long  will  it  take  the  adenoid  child 
to  finish  the  eight  grades.''  How  long  the  child  with 
enlarged  tonsils,  with  teeth  defects,  etc..''  It  is  contended 
that  if  physical  defects  exert  a  retarding  influence  on 
pedagogical  efficiency  the  progress  must  be  slower  for 
physical  defectives  than  for  normal  pupils. 

Only  one  study  of  this  sort  has  been  made,  namely  the 
New  York  study  of  the  3,304  children  whose  ages  ranged 
from  ten  to  fourteen.  The  percentages  of  loss  of  peda- 
gogical efficiency  was  determined  for  groups  of  these  chil- 
dren  suffering  from  different  kinds   of  physical  defects. 


PHYSICAL  HANDICAPS  311 

The  loss  in  time,  based  on  the  average  number  of  years 
completed  (4.94)  by  the  pupils  who  had  no  physical  handi- 
caps, was  as  follows :  for  defective  vision,  0  per  cent ;  for 
seriously  defective  teeth,  5.9  per  cent ;  for  defective  breath- 
ing, 7.2  per  cent;  for  enlarged  tonsils,  8.9  per  cent;  for 
adenoids,  14.1  per  cent;  for  enlarged  glands,  14.9  per 
cent,  and  for  other  defects,  8.5  per  cent.  On  the  average, 
the  retarding  influence  of  the  physical  handicaps  appeared 
to  amount  to  8.8  per  cent  (Ayres). 

This  method  marks  some  advance  upon  previous 
methods,  but  its  crudity  is  apparent.  It  insures  little,  if 
any,  control  of  conditions.  It  makes  no  attempt  to  isolate 
individual  defects,  except  in  a  crude  fashion.  It  is  obvious 
that  various  defects  may  coexist  in  the  same  child,  and 
that  a  variety  of  compHcations  may  exist.  The  method 
fails  to  evaluate  the  relative  influence  of  the  contributing 
factors,  whether  these  be  physical,  sociological,  environ- 
mental or  mental.  The  physically  'normal'  children  used 
as  standards  were  probably  only  relatively  free  from 
defects.  Moreover,  if  anyone  should  use  eight  years  as 
the  standard  time  required  by  the  normal  child  to  complete 
the  elementary  course  he  would  be  using  a  purely  theoreti- 
cal criterion.  There  are  no  direct  data  available  to  show 
that  the  average  child,  or  even  the  child  free  from  physical 
defects,  is  able  to  finish  the  eight  elementary  grades  in 
eight  years.  In  fact,  the  data  we  have  indicate  that  the 
average  cliild  requires  9.34  years  to  finish  the  eight  grades, 
for  in  an  investigation  of  promotion  in  grades  one  to  five 
in  twenty-nine  American  cities  it  appeared  that  in  no  city 
did  the  average  child  finish  the  four  years  on  time.  The 
shortest  was  4.08  years,  the  longest  6.22,  while  the  average 
was  4.67.  For  every  rapid-progress  pupil  there  were 
found  from  eight  to   ten  slow-progress  pupils    (Ayres). 


312    MENTAL  HEALTH  OF  SCHOOL  CHILD 

It  is  therefore  apparent  that  the  only  legitimate  basis  of 
comparison  is  the  number  of  years  actually  required  to 
finish  the  elementary  course  either  by  the  average  pupil  or 
by  the  pupil  relatively  free  from  defects,  and  not  the 
theoretical  eight  years. 

6.  Finally,  a  sixth  method  approaches  the  problem 
from  an  entirely  different  point  of  view,  namely  from  the 
orthogenetic  standpoint.  It  consists  in  correcting  the 
child's  physical  handicaps  by  proper  orthosomatic  treat- 
ment, and  then  ascertaining  whether  or  not  there  is  any 
improvement  in  scholarship,  mental  vigor,  working  capa- 
city, classroom  attendance,  promotion  or  deportment.  If 
we  wish  to  determine  whether  adenoids  interfere  with 
mental  development,  let  us  remove  them  and  find  out  what 
happens. 

Of  studies  of  this  kind  there  are  innumerable  sporadic 
observations,  and  one  psycho-experimental  investigation. 

In  Philadelphia,  seventy  more  or  less  retarded  pupils  in 
grades  one  to  four  were  operated  for  adenoids.  The 
reports  of  the  teachers,  based  on  sixty-three  cases,  indi- 
cated that  30  per  cent  'improved  considerably,'  40  per 
cent  'improved,'  25  per  cent  did  not  improve,  1.6  per  cent 
deteriorated  and  3  per  cent  deteriorated  considerably. 
Of  those  who  had  two  chances  for  promotion,  6.3  per  cent 
were  promoted  twice,  16  per  cent  failed  twice,  while  33.3 
per  cent  were  promoted  once  and  a  hke  number  failed  once. 
On  the  other  hand,  of  those  with  one  opportunity  for 
promotion,  11  per  cent  were  promoted,  while  31.7  per  cent 
failed  (Cornell).  The  promotion  record  was  thus  decid- 
edly poor.  It  is  possible,  however,  that  the  time  for 
promotion  came  before  the  orthogenic  effects  of  the 
operations  had  become  effective. 

In  New  York  City,  of  eighty-seven  cases  operated  for 


PHYSICAL  HANDICAPS  313 

enlarged  tonsils  and  adenoids,  we  are  told  that  'many' 
(that  exasperatingly  vague  term!)  advanced  three  grades 
during  the  rest  of  the  school  year,  and  that  only  three  lost 
time  (Cronin). 

In  the  same  city,  thirty-five  pupils  who  were  serious 
retardates  in  the  regular  or  ungraded  classes  were  fitted 
with  glasses  in  January,  1912,  to  overcome  hyper- 
metropia  and  myopia.  The  teachers  were  asked  to  make 
estimates  of  the  pupils'  work  and  conduct  at  this  time,  and 
again  in  June,  1912.  The  record  of  promotions  showed 
that  nineteen  of  the  twenty-five  pupils  in  the  regular 
grades  were  promoted,  one  of  the  ten  ungraded  pupils  was 
promoted  to  a  regular  grade,  while  seven  made  very  slow 
progress  and  two  made  no  progress.  All  were  reported 
to  have  improved  in  habits,  disposition  and  conduct. 

A  random  examination  in  Cleveland,  in  1910-1911,  of 
the  records  of  224  corrected  cases  indicated  that  24  per 
cent  had  improved  decidedly  in  scholarship,  21.4  per  cent 
had  improved  in  deportment  and  33  per  cent  in  attendance. 

In  contrast  with  the  above  observational,  deportment 
or  promotion  methods  of  estimating  the  orthophrenic 
effects  of  the  correction  of  physical  defects,  is  an  experi- 
mental investigation  by  laboratory  methods  under  con- 
trolled conditions  undertaken  to  discover  whether  or  not 
the  mental  efficiency  of  a  group  of  children  could  actually 
be  elevated  by  proper  orthosomatic  mouth  treatment. 
The  description  of  this  experiment  and  the  discussion  of 
the  results  have  been  given  in  Chapters  XIII  and  XIV 
and  are  therefore  omitted  here. 

This  brief  review  of  the  present  status  of  the  problem 
thus  indicates  that  before  long  we  may  look  forward  to 
the  creation  of  a  genuine  science  of  orthophrenics,  so  that 
we  shall  be  able  to  say  with  greater  accuracy  than  before 


314    MENTAL  HEALTH  OF  SCHOOL  CHILD 

what  kinds  of  physical  obstructions  cause  the  greatest 
amount  of  retardation,  what  degree  of  defect  is  necessary 
to  cause  mental  impairment,  what  mental  functions  are 
most  affected  by  various  disabiUties,  to  what  extent 
orthosomatic  treatment  will  entirely  remove  the  mental 
damage  caused  by  various  defects,  and  to  what  extent 
reliance  must  also  be  placed  on  differential  orthophrenic 
or  corrective  pedagogic  treatment.  The  problem  is 
extremely  complex,  and  its  effective  solution  demands  the 
cooperative  efforts  of  the  expert  psycho-educational 
examiner,  physician  and  teacher.  Moreover,  investiga- 
tions should  be  made  from  purely  disinterested  scientific 
motives  by  private  and  pubHc  research  foundations  of  the 
orthogenic  effects  of  various  orthosomatic  and  ortho- 
phrenic  measures.  These  investigations  should  cover  the 
various  psychological,  pedagogical,  sociological,  dento- 
medical,  anthropometric  and  hereditary  aspects  of  the 
problem.  (One  writer  has  already  made  an  attempt  to 
partially  carry  out  this  suggestion.^) 

2  KoHNKY.  Preliminary  Study  of  the  Effect  of  Dental  Treatment 
upon  the  Physical  and  Mental  Efficiency  of  School  Children.  Journal 
of  Educational  Psychology,  1913,  4:571fP. 


CHAPTER  XVI 

MEDICAL  AND  DENTAL  INSPECTION   IN  THE 
CLEVELAND  SCHOOLS^ 

I.     The  Development  of  Medical  School  Inspection 

In  1906,  the  Board  of  Health  of  Cleveland  appointed 
twenty-six  ward  physicians,  a  part  of  whose  duties  con- 
sisted in  inspecting,  every  other  day,  the  public  and  paro- 
chial schools  of  their  districts  for  the  detection  and 
exclusion  from  the  schools  of  pupils  suffering  from  con- 
tagious and  communicable  diseases.  But  excluding  chil- 
dren, in  conformity  with  the  law,  with  such  communicable 
diseases  as  pediculosis,  scabies,  impetigo,  etc.,  created 
serious  school  problems.  Many  children  thus  excluded 
remained  out  of  school  for  days ;  they  received  no  correct- 
ive treatment  at  home,  hence  when  they  returned  they  were 
often  in  a  worse  condition  than  when  they  left ;  their  exclu- 
sion seriously  handicapped  the  regular  work  of  the  class- 
room, for  these  pupils  frequently  stood  in  greatest  need 
of  the  classroom  processes,  and  they  had  to  be  excluded  in 
large  numbers  owing  to  the  enormous  prevalence  of  some 
form  or  other  of  communicable  disease.  In  a  number  of 
the  congested  foreign  districts  of  the  city,  conditions  were 
such  that  not  only  would  exclusion  result  in  a  breakdown 
of  the  school   system  from   the  point   of  view   of  school 

1  Reprinted,  with  alterations,  from  The  Psychological  Clinic,  1910, 
pp.  93-108. 


316    MENTAL  HEALTH  OF  SCHOOL  CHILD 

attendance,  but  a  large  percentage  of  children  were  forced 
to  labor  under  the  handicap  of  needless  suffering,  owing  to 
the  ignorance,  indifference  or  poverty  of  the  parents. 

To  checkmate  the  evils  due  to  those  conditions  and  to 
demonstrate  to  the  Board  of  Education  the  importance  of 
a  system  of  medical  inspection  that  should  embrace  exami- 
nation for  physical  defects,  certain  inspectors,  working 
through  the  Sanitation  Committee  of  the  Chamber  of  Com- 
merce, volunteered  their  services  without  compensation  if 
the  Board  of  Education  would  provide  inspection  stations 
in  those  schools  in  which  the  need  was  the  most  pressing. 
The  Board  established  five  of  these  stations  in  schools  which 
drained  large  foreign  populations,  each  station  in  charge 
of  a  graduate  nurse  of  the  Visiting  Nurses'  Association. 
The  first  was  organized  at  the  Murray  Hill  School  in  1908. 
School  dispensaries  or  clinics,  among  the  first  of  the  sort 
in  the  country,  were  connected  with  two  of  these  stations 
(Murray  Hill  and  Marion).  Three  others  were  subse- 
quently added.  The  equipment  of  these  clinics,  provided 
at  the  expense  of  the  School  Board,  varies,  but  consists 
mainly  of  diagnostic  appliances  for  examining  the  ear, 
nose  and  throat,  eye  test  cards,  instruments  for  removing 
adenoids  and  tonsils  and  for  performing  the  simpler  opera- 
tions, ointments,  solutions  for  treating  communicable 
diseases,  an  instrument  case,  a  metal  stand  for  basins,  glass 
top  table,  couch,  enameled  chairs,  etc.  While  the  primary 
aim  has  not  been  to  supply  free  treatment  at  the  clinic, 
emergency  cases  receive  prompt  attention,  and  at  one  of 
the  schools,  the  Murray  Hill  (and  in  a  measure,  at  a  couple 
of  the  others  also),  all  cases  of  infection,  of  wax  and  sup- 
purating ears,  atrophic  rhinitis  and  all  marked  cases  of 
adenoids  and  hypertrophied  tonsils  have  received  remedial 
or  operative  treatment. 


MEDICAL  AND  DENTAL  INSPECTION     317 

The  inspection  work  has  been  rendered  practically 
effective  through  the  'follow-up'  work  and  the  diversified 
ministration  of  the  school  nurse.  She  makes  a  record  of 
the  examination,  and  sends  a  copy  to  the  child's  parents. 
She  visits  the  home  to  ascertain  whether  the  physician's 
advice  has  been  followed.  If  it  has  not,  recourse  is  had  to 
the  gentle  art  of  suasion,  or  in  extreme  cases  of  neglect  the 
juvenile  court  is  invoked.  Indigent  parents  are  advised  to 
take  the  child  to  a  free  dispensary  or  hospital  clinic.  She 
looks  after  many  of  the  minor  troubles  while  the  child 
remains  in  school,  attends  to  ordinary  dressings  and  the 
child's  hygiene  in  general,  inspects  the  rooms  daily  and 
treats  at  the  dispensary  the  simpler  infections  of  the  skin 
and  head,  while  referring  the  more  complicated  cases  to 
the  medical  inspector.  After  treatment  she  follows  the 
child  home  and  instructs  the  mother  how  to  continue  treat- 
ment, or,  in  case  the  mother  is  employed,  takes  personal 
charge.  She  also  teaches  the  older  girls  in  school  how  to 
apply  bandages  and  antiseptics,  how  to  prepare  common 
disinfectants  and  antidotes,  and  explains  the  importance  of 
sanitation  and  personal  cleanhness.  She  gives  baths  to  the 
girls  where  showers  are  provided.  Hers  is  a  diversified 
calling,  filled  with  noble  achievement.  In  one  month  in 
the  Murray  Hill  School,  nurses'  aid  was  given  to  680  cases, 
while  75  homes  were  visited.  A  monthly  report  of  nurses' 
aid  in  the  Harmon  School  included  195  baths,  215  treat- 
ments for  impetigo,  50  for  pediculosis,  50  ocular  cases 
were  referred  to  the  Humane  Society  and  one  to  the  Blind 
Institute.  Similar  cases  from  another  school  in  a  con- 
gested section  (Eagle)  are  frequently  referred  to  dental, 
medical  and  babies'  dispensaries,  and  family  physicians. 
In  1907,  through  the  cooperation  of  nurses,  physicians, 
teachers,  principals,  parents,   dispensaries,   free  hospital 


318    MENTAL  HEALTH  OF  SCHOOL  CHILD 

clinics  and  philanthropic  organizations,  over  3,300  pupils 
received  aid  of  the  following  nature : 

Number  Per  cent 

Glasses  secured  by 990  29.2 

Other  eye  treatment 1,016  30. 

Ear  treatment 228  6.7 

Nasal  treatment 379  11.1 

Dental  treatment   664  19.6 

Unclassified    Ill  3.4 

Total    3,388  100. 

To  the  thousands  of  children  and  parents  who  have 
profited  from  this  humanitarian  and  philanthropic  minis- 
tration, the  school  nurse  has  become  a  guardian  angel. 
There  has  been  no  frenzied  outcry  in  Cleveland  against  this 
physical  welfare  work  either  on  the  part  of  ignorant  or 
superstitious  parents,  or  studied  opponents  of  'communism' 
or  'socialism.'  Objections,  so  far  as  they  have  been  heard 
at  all,  have  been  directed  by  parents  against  operations  or 
by  physicians  against  free  treatment.  Some  parents 
object  to  the  removal  of  tonsils,  through  the  fear  that  this 
will  injure  the  voice;  and  others  to  the  wearing  of  glasses, 
because  they  fear  that  once  worn  they  can  never  be 
discarded. 

What  a  boon  this  work  has  been  to  the  schools !  Instead 
of  ruthlessly  excluding  infected  children  from  the  schools 
and  thereby  clogging  the  school  machinery,  the  district 
physician  has  been  superseded  by  the  school  medical 
inspector  and  the  school  nurse,  and  the  child  has  been 
permitted  to  remain  in  school  without  the  danger  of 
infecting  his  fellows.  The  statistics  from  one  of  the  medi- 
cal stations  (Marion  School)  show  most  impressively  how 


MEDICAL  AND  DENTAL  INSPECTION     319 

irregular  attendance  can  be  effectually  counteracted.  It 
has  been  computed  by  the  principal  that  the  school  nurse 
and  dispensary  between  January  1  and  June  1,  1909, 
saved  1871  days  for  the  child  and  the  school.  Without 
these  adjuncts  of  the  school,  the  following  cases  of 
exclusion  would  have  been  necessary : 

43  infections  for  5  days,  or 215  days. 

118  cases  of  conjunctivitis  for  5  days 590  days. 

23  cases  of  scabies  for  5  days   115  days. 

25  cases  of  ringworm  for  10  days 250  days. 

57  cases  of  pediculosis  of  head  for  3  days.  171   days. 

6  cases  of  pediculosis  of  skin  for  10  days  60  days. 

94  cases  of  impetigo  for  5  days 470  days. 

Total     • 1,871   days. 

With  a  rigidly  enforced  exclusion  law  these  children,  and 
others  who  might  have  been  infected  by  them,  would  have 
been  deprived  of  the  processes  of  the  schools  for  about  ten 
years  in  the  aggregate,  at  a  tremendous  economic  loss  to 
the  taxpayer.  This  enormous  waste  was  obviated  at  a 
merely  nominal  cost  to  the  community.  This  saving  takes 
no  account  of  the  increased  working  efficiency  which 
resulted  from  properly  caring  for  the  following  283  non- 
communicable  ailments  during  the  corresponding  period: 

79  cases  of  minor  injuries. 

65  cases  of  throat  affections. 

40  cases  of  burns. 

20  cases  of  chapped  hands. 

19  cases  of  ear  affections. 

12  cases  of  nasal  affections. 

10  cases  of  foreign  bodies  in  eyes. 

10  cases  of  removed  tonsils. 


320    MENTAL  HEALTH  OF  SCHOOL  CHILD 

10  cases  of  eczema. 

9  cases  of  adenoids. 

7  cases  of  canker  sores. 

2  cases  of  cold  sores. 

To  render  this  auxiliary  work  of  the  schools  still  more 
effectual,  volunteer  work  in  the  direction  of  feeding  indi- 
gent, anemic  and  underfed  children  has  been  started  in 
some  of  the  schools.  The  Philanthropic  Committee  of  the 
Cleveland  Federation  of  Women's  Clubs  regularly  serves 
a  simple  breakfast  in  the  Eagle  School  to  an  average  of 
thirty-six  pupils  per  day. 

As  a  result  of  this  hygienic  and  medical  work  the 
attendance  records  have  reached  unprecedented  heights 
in  these  usually  irregular  districts.  The  principals  esti- 
mate that  90  per  cent  of  the  affected  pupils  have  remained 
in  school  who  would  in  the  absence  of  this  service  have 
dropped  out  for  several  days.  This  fact  is  of  vital  signifi- 
cance to  the  schools  and  the  community  in  view  of  the 
contention'  that  irregular  attendance  is  the  chief  cause  of 
backwardness  and  non-promotion,  and  that  ill  health  is 
the  chief  cause  of  irregular  attendance.  It  was  found  in 
New  York  that  43  per  cent  of  the  boys  and  48  per  cent  of 
the  girls  of  the  16,000  completing  the  eighth  grade  in 
1909  were  absent  from  school  from  illness.  The  net  loss 
through  inattendance  to  the  girls  amounted  to  3.5  per 
cent  of  the  length  of  the  term,  and  to  the  boys  3.2  per  cent. 
The  causes  of  these  absences  were:  measles,  2,108;  scarlet 
fever,  1,550;  diphtheria,  1,002;  pneumonia,  621;  whoop- 
ing cough,  473 ;  chicken  pox,  387 :  mumps,  288 ;  tonsilitis, 
251;  typhoid  fever,  219;  rheumatism,  200;  malaria,  151. 

2  Ayres,  Leonard  P.  Irregular  Attendance — A  Cause  of  Retarda- 
tion, The  Psychological  Clinic,  Vol.  Ill,  No.  1,  March  15,  1909. 


MEDICAL  AND  DENTAL  INSPECTION     321 

Without  any  system  of  medical  inspection  and  nurses' 
supervision  in  the  New  York  schools,  these  absences  would 
probably  have  been  increased  from  minor  infections  such 
as  those  which  prevailed  in  the  Marion  School. 

Since  the  work  attempted  in  these  stations  has  not  con- 
templated a  routine  examination  of  every  child,  and  since 
the  form  and  completeness  of  the  records  kept  have  varied 
more  or  less  with  each  inspector,  it  is  impossible  to  state 
how  many  cases  have  been  examined  by  the  physicians  since 
the  work  was  launched,  or  how  many  defects  (particularly 
the  non-communicable,  physical  abnormalities)  have  been 
discovered,  or  what  the  relative  proportions  of  different 
kinds  of  physical  defects  are,  or  precisely  how  the  influence 
upon  mental  retardation  differs  with  different  defects,  or 
what  have  been  the  subsequent  effects  upon  the  physical 
growth,  the  increase  in  body  weight  and  the  mental  effi- 
ciency of  the  hygienic  and  medical  treatment  of  the 
affected  child.  The  magnitude  of  the  inspection  work  may 
be  inferred,  however,  from  the  records  at  the  Murray  Hill 
and  Marion  schools,  where,  during  the  months  of  January, 
February  and  March,  28,820  inspections  were  made. 
Moreover,  I  have  been  able  to  obtain  three  sets  of  reliable 
data,  one  from  the  printed  records  and  two  in  response  to 
a  questionnaire.  The  first  shows  the  ratio  of  the  various 
physical  defects  obtaining  among  children  in  the  better 
sections  and  congested  districts  of  the  city.  During  the 
academic  year  1906-1907  the  department  of  physical 
training  of  the  public  schools  examined  30,000  children 
with  respect  to  the  conditions  of  the  eyes,  ears,  nose  and 
throat  only,  in  grades  three  to  seven.  The  following  table 
is  based  upon  the  examination  of  1,284  pupils  in  two 
schools,  one  in  the  'East  End'  and  the  other  in  a  congested 
district : 


East  End 
Per  cent 

Congested 
District 
Per  cent 

616 

6.4 

1.8 

32.4 

71.1 

27.8 

35.2 

5.2 

1.8 

8.9 

12.8 

45.1 

57.1 

12.1 

14.7 

1.3 

15.7 

27.8 

46.4 

18.55 

28.4 

322    MENTAL  HEALTH  OF  SCHOOL  CHILD 


Number  examined 668 

Wearing  glasses    

Defective   vision    

Other  symptoms  of  eye  trouble.  . 

Defective  hearing 

Diseased  ears    

Obstructed  nasal  breathing   .... 

Habitual  mouth  breathers    

Teeth  very  defective    

Teeth  very  dirty     

Average    


Dr.  L.  W.  Childs  has  more  recently  made  a  routine 
examination  of  425  pupils  in  the  lower  grades  (from  the 
second  to  the  fifth)  in  the  Murray  Hill  School,  where  97 
per  cent  of  the  school  population  is  Italian,  covering  the 
ear,  nose  and  throat,  and  has  kindly  supplied  me  with  the 
results  of  his  careful  survey,  to  wit : 

Per  cent 

Retraction  of  drum  membranes  of  both  ears 32 

Retraction  of  membrane  of  one  ear 16 

Impaired    hearing    22 

Enlargement  of  both  tonsils    22 

Enlargement  of  one    tonsil    3^/2 

Adenoids    13 

Impacted  wax  in  ears   13 

Enlarged  cervical  glands    10 

Goitre    7 

Atrophic   rhinitis    5 

Deviated  septum    4 

Suppurating  ears    2 

Hypertrophied  inferior  turbinals 2 


MEDICAL  AND  DENTAL  INSPECTION     323 

In  a  still  later  examination  of  120  sixth,  seventh  and  eighth 
grade  girls  in  the  same  school,  32  per  cent  suffered  from 
goitre  and  16  per  cent  from  anemia. 

In  a  routine  examination  of  the  972  pupils  in  the  eight 
grades  of  Mayflower  School  (station  opened  March  25, 
1909),  the  inspector,  Dr.  S.  A.  Weisenberg,  to  whom  I 
am  indebted  for  a  full  report,  found  the  most  prevalent 
troubles  to  be  the  following : 

Per  cent 

Pediculosis     51 

Defective  eyesight 7 

Miscellaneous  eye  cases 13 

Eye  troubles,  total 20 

Miscellaneous  throat  cases    8.4 

Hypertrophied  tonsils    4.5 

Tonsilitis     2.7 

Adenoids    2.2 

Adenitis     1.3 

Throat  troubles,  total 19.1 

Impetigo    9 

Injuries     8.2 

Miscellaneous  ear  cases 4.5 

Chronic  rhinitis    1.6 

Nasal  defects    1.3 

Nose  troubles,  total 2.9 

Over  78  per  cent  of  these  children  were  Jewish,  nearly  half 
of  these  being  Russian  Jews  (47.9  per  cent). 

That  the  conditions  revealed  by  these  medical  surveys  in 
Cleveland  are  paralleled  in  other  centers  of  population 
has  been  shown  in  Chapter  I.  Of  course,  under  the  present 
indefinite  standards  of  conducting  school  medical  inspec- 


324    MENTAL  HEALTH  OF  SCHOOL  CHILD 

tion,  and  under  the  rather  chaotic  methods  of  recording 
the  findings,  it  is  not  possible  to  state  whether  the  nation- 
wide figures  exaggerate  or  minimize  the  true  state  of 
affairs.  School  medical  inspection  work  cannot  command 
the  respect  of  scientific  men  unless  it  is  properly  standard- 
ized. There  is  urgent  need  for  the  adoption  of  more  uni- 
form and  definite  standards,  practices  and  policies  for 
conducting  physical  inspections  in  the  schools.  At  present 
some  inspectors  record  only  serious  affections  or  affections 
requiring  treatment,  while  others  record  all  sorts  of  minor 
or  negligible  defects.  There  is  diversity  of  opinion  as  to 
the  amount  of  deviation  necessary  to  constitute  sensory 
defects  {e.g.,  of  vision  and  hearing).  Thus  A.  E.  Taussig, 
M.D.,  maintains  that  the  criterion  of  defective  vision 
should  be  a  degree  of  acuity  less  than  ^%o-  The  methods 
of  recording  the  results  of  the  examinations  differ  widely 
in  different  systems.  Many  give  no  indication  as  to  which 
are  the  principal  defects  discovered;  many  do  not  specify 
clearly  the  exact  nature  of  the  defects;  some  group  the 
secondary  troubles  with  the  primary,  the  contagious  dis- 
eases with  the  non-contagious  physical  deviations,  the 
temporary  and  curable  ailments  with  the  non-curable  or 
protracted  defects ;  some  give  no  individual  records  for 
visual  and  auditory  acuity  in  comparative  objective  meas- 
ures for  each  eye  and  ear  separately  ( although  such  infor- 
mation is  of  paramount  value  to  the  teacher  in  enabling 
her  to  seat  uncorrected  children  judiciously)  ;  others  omit 
the  age,  sex,  nationality,  grade,  home  and  community  con- 
ditions of  the  child  (although  such  details  are  of  surpass- 
ing importance,  to  enable  us  to  correlate  physical 
defectiveness  and  disease  with  age,  sex,  nationality  and 
environment)  ;  and  practically  all  omit  reference  to  the 


MEDICAL  AND  DENTAL  INSPECTION     325 

mental  condition,  disposition  and  behavior  of  the  child 
prior  to  inspection  and  treatment,  and  nearly  all  lack  a 
'follow-up'  form  of  card  on  which  to  record  the  results  of 
treatment  upon  the  cliild's  subsequent  mental  efficiency, 
disposition,  deportment,  health,  increase  in  weight  and 
physical  growth  and  development.  That  the  latter  has 
received  scant,  if  any,  scientific  study  is  no  doubt  due  to 
the  difficulty  of  obtaining  pedagogical  and  psychological 
measures  which  shall  be  objectively  and  scientifically  valid. 
The  classroom  registers  and  the  judgments  of  the  teachers 
surely  have  their  values,  but  the  grading  and  judgments 
of  the  teachers  are  so  variable  that  to  measure  by  them  the 
child's  increasing  proficiency  as  the  result  of  treatment  in 
quantitative  terms  is  out  of  the  question.  Nevertheless  a 
'follow-up'  system  of  recording  the  influence  of  various 
forms  of  treatment  upon  various  kinds  of  pedagogical 
defects  based  upon  the  teachers'  marks  and  opinions  is 
better  than  no  system  at  all,  and  is  imperatively  needed 
unless  we  are  content  to  be  empiricists  in  this  newly  organ- 
ized branch  of  community  and  school  work.  To  develop 
tliis  work  aright  we  must  have  accurate  knowledge  of  the 
influence  of  various  abnormalities  and  of  their  treatment 
upon  mental  and  physical  development.  Taussig  has 
recently  proposed  a  means  of  measuring  the  influence  of 
physical  defects  upon  school  work;  and  the  same  means 
might  be  used  to  measure  the  effects  of  treatment.  He 
would  calculate  the  average  grade  of  proficiency  for  each 
age  for  the  normal  and  defective  pupils  by  multiplying 
the  number  of  children  in  each  grade  by  the  number  of  the 
grade.  The  average  grade  can  then  be  secured  by  divid- 
ing the  result  by  the  total  number  of  children.  This  gives 
a    quasi-objective    measure,    but,    again,    it    assumes    the 


326    MENTAL  HEALTH  OF  SCHOOL  CHILD 

accuracy  of  the  teachers'  marks  and  the  correctness  of  the 
school  classification.  Assuming  a  fair  degree  of  accuracy 
for  the  individual  markings,  the  scheme  offers  an  approxi- 
mate criterion  for  gauging  the  scholastic  influence  of 
physical  orthogenesis. 

But  a  scheme  by  which  to  supplement  the  teacher's 
grades  and  opinions  by  means  of  careful  psychological 
tests  of  the  pupil's  quickness  of  perception,  rapidity  of 
association,  strength  of  immediate  visual  and  auditory 
memory,  strength  of  grip,  ability  to  spell  and  add,  etc., 
carried  out  a  short  time  prior  to  treatment  and  subse- 
quently at  different  intervals,  will  eventually  command 
the  attention  of  school  medical  inspection  and  psychologi- 
cal departments.  Such  tests  are  perfectly  feasible  and 
will  enable  us  to  quantify  the  influences  of  orthosomatic 
treatment  upon  the  working  capacity  of  the  pupil  (see 
Chapters  XIII  and  XIV). 

But  to  return  from  this  digression  to  the  medical  inspec- 
tion work  in  Cleveland.  The  conditions  revealed  by  the 
volunteer  inspections  in  the  schools  and  the  humanitarian 
work  performed  by  the  nurses  and  physicians  in  relieving 
needless  physical  suffering,  which  interfered  with  the 
working  efficiency  of  both  the  child  and  the  school,  demon- 
strated to  the  Board  of  Education  the  urgency,  on 
economic,  educational  and  moral  grounds,  of  establishing 
as  an  integral  part  of  the  schools  a  department  of  medical 
supervision  and  inspection.  Such  a  department,  under  the 
administrative  charge  of  the  director  of  schools,  was  put 
into  operation  on  the  first  of  April.  It  has  at  its  disposal 
an  annual  budget  of  $30,000.  It  has  in  its  employ  one 
supervisor  at  a  salary  of  $3,000  per  annum,  fifteen  medical 
assistants   or  inspectors   at  $100   per   month   for  twelve 


MEDICAL  AND  DENTAL  INSPECTION     327 

months  per  year,  ten  nurses  at  $60  per  month  the  first 
year,  $70  the  second,  $75  the  third  and  $80  thereafter, 
and  one  clerk  at  $1,000  per  annum.  The  department  con- 
templates the  inspection  of  all  the  pupils  to  determine  their 
state  of  health  and  the  presence  of  diseased  conditions  and 
physical  anomalies.  Teachers  and  parents  will  receive 
advice  on  the  diseases  and  defects  found,  with  recommen- 
dations for  their  rehef ;  the  pupils  and  teachers  will  receive 
advice  on  the  safeguarding  of  their  health,  and  suggestions 
will  be  offered  respecting  the  course  of  study,  construction 
of  buildings,  etc.  Records  in  duplicate  will  be  on  file  at 
the  schools  and  the  headquarters  of  the  department,  and 
will  be  sent  home  to  the  parents.  These  records  will 
accompany  the  child  throughout  his  course  in  the  grades. 
It  is  expected  that  the  records  will  be  made  unusually 
complete  and  accurate.  The  city  will  be  divided  into 
fifteen  districts,  comprising  about  six  schools  each,  with 
one  physician  and  nurse  in  charge  of  each,  making  each 
physician  responsible  for  inspecting  somewhat  less  than 
5,000  children  (each  of  the  two  hundred  inspectors  in 
New  York  has  about  4,000  children  under  his  care,  wliile 
each  of  Chicago's  one  hundred  has  approximately  6,000). 
By  thoroughly  inspecting  the  first  year  entrants  it  is 
believed  that  the  work  will  be  materially  lightened  in  the 
upper  grades.  Free  treatment  is  not  yet  a  part  of  the 
program.  The  rules  and  regulations  of  the  department 
are  made  by  the  Board  of  Education  and  not  by  the  Board 
of  Health.  School  medical  inspection  should  be  under  the 
administrative  control  of  boards  of  education  instead  of 
boards  of  health.  Actually  in  1911  only  106  systems  were 
under  boards  of  health  as  against  337  under  boards  of 
education. 


328    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

H.  Opening  of  the  National  Campaign  on  Oeal 
Hygiene  Under  the  Auspices  of  the  National 
Dental  Association,  the  Ohio  State  Dental 
Society  and  the  Cleveland  Dental  Society. 

In  1908  the  Committee  on  Education  and  Hygiene  of 
the  Cleveland  Dental  Society  reported  a  plan  for  dental 
education  in  the  public  schools  of  the  city,  embracing 
among  other  matters  a  course  of  lectures  to  be  given  to 
the  teachers.  The  plan  was  censored  and  criticised  by  the 
Dental  Society  and  given  scant  consideration  by  the  Board 
of  Education.  Nothing  was  accomplished  beyond  the 
issuing  of  a  bulletin  of  information  on  the  care  of  the 
teeth  by  the  superintendent  of  schools  to  the  teachers,  who 
were  directed  to  impart  the  information  to  the  children. 
Somewhat  over  a  year  later  a  free  dental  chnic  was  estab- 
lished at  the  City  Hospital.  The  venture  proved  largely 
unsuccessful,  due  to  the  unfavorable  location  of  the  clinic. 
Inspection  trips  were  then  made  to  Boston,  New  York, 
Rochester,  Birmingham,  Ala.,  and  other  places  for  the 
purpose  of  studying  the  methods  employed  for  the  dental 
education  of  school  children.  At  this  juncture,  the  chair- 
man of  the  Cleveland  Committee  on  Education  and 
Hygiene  became  chairman  of  the  Oral  Hygiene  Committee 
of  the  National  Dental  Association.  With  the  oral 
hygiene  headquarters  established  in  Cleveland,  and  data 
available  from  the  cities  visited,  the  campaign  began 
afresh.  Permission  was  received  from  the  Board  of 
Education  to  conduct  a  dental  survey  in  four  representa- 
tive schools.  This  survey  was  made  in  one  day  by  about 
forty  dentists.  The  detailed  results  are  embodied  in  the 
following  table.  The  table  is  not  absolutely  accurate, 
owing  to  the  haste  with  which  the  work  had  to  be  done,  and 


MEDICAL  AND  DENTAL  INSPECTION     329 

the  occasional  misinterpretation  of  the  instructions  by 
some  of  the  examiners.  Thus  some  examiners  thought  that 
*good,'  'fair'  or  'bad'  referred  to  the  teeth  only,  and, 
therefore,  some  mouths  were  marked  good  when  the  oral 
conditions  were  unhygienic.  The  results  thus  rather 
minimize  than  overemphasize  the  actual  oral  conditions 
found.  The  figures  from  the  Marion  School  are  the  most 
accurate. 


Murray 
Hill 


Doan. 


Waterson. 


Marion. 


Number  of  Pupils  Examined. 
Condition  of  the  Mouth  : 

Good 

Fair 

Bad 

Condition  of  the  Gums : 

Good 

Bad 

Use  Tooth  Brush : 

Yes 

No 

Teeth  Filled : 

Yes 

No 

Malocclusion : 

Yes 

No 

Teeth  containing  Cavities 

Teeth  Extracted 

Nationality : 

American 

German 

English 

Italian 

Russian 

Slavic 

Bohemian 

Swedish 

Irish 

French  

Norwegian 

Polish 

Number  of  Perfect  Mouths . . , 
Number  of  Defective  Mouths 
Number  of  Cavities 


346 
381 
134 


594 
253 


101 
762 


9 
843 


230 
633 


691 

132 
429 
117 


504 
169 


524 
161 


275 
404 


421 
452 


641 
69 


657 
1 
6 
1 


62—  7.17% 

802—92.83% 

3920 


20—  2.9% 

671—97.1% 

4294 


298 

135 
99 
63 


221 
73 


193 
100 


102 
191 


93 
169 


257 
14 


198 

20 

45 

7 


14—  4.6 
284—95.31% 
1342 


244 
336 
241 


447 
300 


243 
456 


72 
707 


343 

308 


745 
125 


116 
73 
11 

420 


2677 


13—  1.5% 

811—98.43% 

5505 


330    MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  2,677  mouths  examined  contained  15,061  dental 
cavities,  or  an  average  per  mouth  of  5.6  (somewhat  above 
the  Worcester  average,  4.85)  ;  in  2,145  mouths,  or  in 
about  80  per  cent,  the  teeth  were  not  filled;  malocclusion 
affected  1,087,  or  somewhat  over  40  per  cent;  in  1,479,  or 
55  per  cent,  a  tooth  brush — the  instrument  that  is 
mightier  than  the  sword  in  national  human  defense — was 
never  used;  the  number  of  defective  mouths  ranged  from 
92  per  cent  to  98  per  cent ;  and  practically  97  per  cent  of 
the  mouths  required  some  sort  of  hygienic  attention  or 
dental  service  to  render  the  mouth  healthy  and  function- 
ally efficient.  As  will  be  seen  in  the  table,  some  of  the 
defects  are  most  prevalent  in  the  schools  with  a  pre- 
ponderant Italian  population — an  indication  of  the  rela- 
tion of  unwholesome  environmental  influences  and  unen- 
Hghtened  or  poverty-stricken  conditions  in  the  home  to 
unsanitary  oral  conditions. 

It  will  be  of  interest  to  recount  some  of  the  results  of 
dental  surveys  in  other  cities.  One  of  the  first,  if  not 
actually  the  first,  inspection  was  made  in  Russia  in  1879. 
Defective  dentures  afflicted  80  per  cent  of  the  inhabitants 
of  St.  Petersburg.  Of  Berlin  school  children,  90  per  cent 
were  similarly  affected  (Ritter),  and  of  100,000  school 
children  examined  in  different  states  of  Germany,  from  81 
per  cent  to  99  per  cent  had  diseased  teeth.  In  Ludlow, 
Mass.,  the  500  pupils  examined  (from  eight  to  fifteen 
years  old)  displayed  palpable  neglect  of  dental  cleanliness, 
very  few  used  brushes,  none  had  received  any  dental  treat- 
ment aside  from  a  few  children  who  had  had  teeth 
extracted,  bacterial  deposits  and  malodorousness  existed 
in  varying  degrees,  some  suffered  from  prolonged  reten- 
tion of  the  temporary  teeth,  while  still  more  had  lost  these 


MEDICAL  AND  DENTAL  INSPECTION     331 

teeth  prematurely,  showing  a  disregard  of  the  value  of 
the  temporary  teeth.  In  New  York,  an  expert  examination 
was  made  of  the  teeth  of  500  boys  and  girls  from  fourteen 
to  sixteen  who  were  applying  for  work  certificates,  on 
behalf  of  the  Children's  Aid  Society.  Less  than  3  per  cent 
of  these  had  sound  teeth ;  456  had  2,808  decayed  teeth,  or 
an  average  of  about  6.1  each,  90  per  cent  of  wliich  could 
be  saved  by  proper  dental  attention.  Gangrenous  pulps, 
or  decayed  pulps  exposing  the  roots,  were  found  in  247 
boys  and  152  girls;  and  only  25  out  of  the  500  had 
received  any  dental  care  other  than  extraction.  In  an  early 
inspection  of  all  the  pupils  in  Cleveland  by  the  ward 
physicians  under  the  direction  of  the  Board  of  Health,  79 
per  cent  of  the  children  were  reported  as  suffering  from 
decayed  or  defective  teeth  (see  also  Chapter  I). 

With  such  distressing  revelations  as  these — and  the 
statistical  data  can  now  be  multiplied  a  hundred-fold — it 
is  little  wonder  that  experts  have  come  to  regard  caries  of 
the  teeth  as  the  'disease  of  the  people,'  a  world-wide  afflic- 
tion of  civilized  nations,  and  the  unsanitary  mouth,  which 
is  the  gateway  to  the  stomach,  as  the  body's  chief  breeding 
place  for  pathogenic  bacteria,  a  hidden  source  of  infection 
Httle  attended  to  because  of  its  hidden  character.  And 
with  these  revelations  the  modern  propagandist  of  the 
body  hygienic  has  rallied  his  forces  about  a  new  battle-cry : 
'Keep  the  mouth  with  diligence,  for  out  of  it  are  the  issues 
of  life,'  'Good  teeth,  good  health' — is  the  modern  ortho- 
genic tocsin.  In  no  branch  of  public  hygiene  are  such 
decisive  results  obtained  and  with  such  small  cost  as  in 
the  dental  treatment  of  school  children. 

The  results  of  the  Cleveland  survey  induced  the  Board 
of  Education,  in  October,  1909,  to  grant  the  request  of 


332    MENTAL  HEALTH  OF  SCHOOL  CHILD 

the  National  Dental  Association,  the  Ohio  Dental  Society 
and  the  Cleveland  Dental  Society,  to  conduct  dental 
examinations  of  all  the  pupils  in  the  pubhc  schools  during 
a  period  of  one  year,  to  treat  gratuitously  all  indigent 
children  so  desiring,  and  to  offer  lectures  in  the  school 
buildings  to  teachers,  parents  and  pupils  on  the  proper 
care  and  use  of  the  teeth  and  mouth.  On  March  18,  1910, 
the  formal  opening  of  these  clinics — four  in  public  schools 
and  one  each  in  St.  Alexis  Hospital  and  the  City  Chnic — 
was  signalized  by  a  convention  in  Cleveland,  at  which 
addresses  were  made  by  the  President  of  the  National 
Dental  Association,  the  Chairman  of  the  Education  and 
Oral  Hygiene  Committee  of  the  Ohio  State  Dental  Society, 
the  Chairman  of  the  Oral  Hygiene  Committee  of  the 
National  Dental  Association,  the  Commissioner  of  Health 
of  Chicago,  the  Superintendent  of  Schools  of  Cleveland, 
the  Dental  Surgeon  of  the  Naval  Academy,  the  Mayor  of 
Cleveland,  the  personal  representatives  of  President 
Taft  and  Governor  Harmon  and  others.  The  exercises 
included  the  formal  dedication  of  the  clinics  and  addresses 
on  various  aspects  of  school  dental  inspection.  The  con- 
vention marked  the  inauguration  of  a  country-wide  cam- 
paign for  the  organization  of  departments  of  dental 
inspection  as  integral  parts  of  the  public  school  systems 
of  our  cities.  It  is  expected  that  one  year  of  volunteer 
work  in  Cleveland  will  demonstrate  that  the  work  is  one  of 
the  most  needed  and  worthiest  undertakings  of  the  schools, 
whether  viewed  from  an  altruistic,  educational  or  economic 
point  of  view.  Special  scholarship  and  deportment  blanks 
will  be  kept  on  which  records  of  the  treatment  will  be  made 
and  of  its  effect  upon  the  subsequent  working  efficiency  and 
behavior    of    the    child    (see    experiment    described    and 


MEDICAL  AND  DENTAL  INSPECTION     333 

discussed  in  Chapters  XIII  and  XIV).  Special  blanks  in 
triplicate,  containing  charts  of  diseased  dentures,  will  be 
furnished  to  the  Director  of  Schools,  the  Cleveland  Dental 
Society  and  to  the  pupil  or  teacher  for  the  parent. 
Parents  who  desire  treatment  for  their  children  on  the 
ground  of  poverty  must  make  application  upon  a  separate 
'indigent'  blank.  The  clinic  patient  will  be  supplied  gratis 
with  a  brush,  tooth  powder,  antiseptic  wash,  plastic  (not 
gold)  fillings  and  pulp  and  root  treatments.  The 
examiners  and  clinicians  will  be  certified  and  assigned  to 
their  respective  schools  by  the  director  of  schools  and  the 
supervisor  of  dental  inspection.  The  material  equipment 
of  the  clinics  is  furnished  by  the  National  and  Ohio  Dental 
Associations,  and  the  dentists  and  assistants  (each 
examiner  will  have  a  woman  assistant)  by  the  Cleveland 
Dental  Society.  Each  examiner  will  donate  one  week's 
services,  or  twelve  half  days.  The  lecture  course  will  be  in 
the  hands  of  twenty  men.  The  expense  incurred  by  the 
Cleveland  Society  amounts,  in  cash  equivalent,  to  about 
$3,491 — $1,866  for  examination  work,  $1,500  for  clinic 
work  and  $125  for  the  lecture  and  educational  work. 

Thus  the  year  1910  marks  the  introduction  upon  a 
volunteer  basis  of  the  first  school  dental  clinic  in  the  United 
States,  six  years  after  the  first  school  dental  clinic  was 
established  in  Strassburg  by  Dr.  Jessen.  (It  is  stated  that 
the  first  free  dental  clinic  in  the  world  was  established  in 
Rochester  over  twenty-five  years  ago  and  that  the  first 
school  dental  clinic  was  established  in  the  same  city 
February  23,  1910.)  The  Strassburg  clinic  is  open  to  all 
school  children  without  charge,  and  is  manned  by  regularly 
registered  dentists,  under  municipal  control.  School  clinics 
of  the  same  type  have  since  been  established  in  thirty-five 


334    MENTAL  HEALTH  OF  SCHOOL  CHILD 

or  more  German  cities.  With  the  better  understanding 
which  we  now  have  of  the  effects  of  the  unhygienic  oral 
cavity  upon  the  health,  happiness,  mental  and  physical 
efficiency  and  the  morals  of  the  child,  it  is  predicted  that 
the  spread  of  the  school  dental  clinic  will  be  no  less  rapid 
in  our  own  country.  (At  this  writing,  it  is  reported  that 
over  200  American  cities  are  providing  dental  inspection. 
In  1910,  J.  H.  and  Thomas  A.  Forsyth  of  Boston  donated 
$500,000  for  the  establishment  of  a  clinic  to  provide  free 
dental  service  to  any  child  from  early  childhood  to  the  age 
of  sixteen.)  It  is  reported  of  a  certain  juvenile  judge  that 
he  always  has  the  teeth  of  his  youthful  culprits  examined 
before  he  imposes  sentence;  and  not  infrequently  the 
penalty  imposed  is  a  trip  to  the  dental  chair.  Match 
manufacturers  subject  their  employees  to  dental  inspection 
and  exclude  all  persons  with  decayed  teeth.  Phosphorous 
necrosis  has  thus  disappeared  among  match  workers. 
Some  hidden  cavity  in  a  tooth  or  unclean  surface  is  often 
a  focus  for  bacterial  deposits.  Such  foci  serve  as  the 
breeding  places  for  germs  causing  acute  infections,  scarlet 
fever,  diphtheria  and  tuberculosis,  and  enlargements  of 
the  glands  of  the  neck  and  throat  may  occur  through 
absorptions  from  these  cavities.  The  gases  and  poisons 
generated  in  an  unsanitary  mouth  and  the  pain  from 
toothache  often  produce  general  and  gastric  neurasthenia, 
indigestion,  ill  health,  irritability,  bad  temper,  mental 
inefficiency,  inability  to  concentrate  attention,  bad  morals, 
and,  it  is  alleged,  even  insanity.  The  machinery  for 
discovering  these  conditions  in  the  schools — the  only 
organized  social  agency  with  anything  like  police  power — 
will  come  inevitably  everywhere.  Will  we  get  the  machin- 
ery for  rectifying  these  conditions,  the  school  dental  dis- 


MEDICAL  AND  DENTAL  INSPECTION     335 

pensary  in  addition  to  the  school  dental  inspection  station? 
Whether  or  not  compulsory  school  clinics  are  desirable, 
some  form  of  pressure  cannot  be  dispensed  "odth  if  this 
work  is  to  realize  proper  returns  upon  the  investment. 
In  one  of  the  German  cities  such  pressure  is  secured  by 
barring  children  with  diseased  teeth  from  the  privileges  of 
the  recreation  grounds,  forest  school  and  vacation  colonies. 
'Without  good  teeth  there  cannot  be  thorough  mastica- 
tion. Without  thorough  mastication  there  cannot  be 
perfect  digestion.  Without  perfect  digestion  there  cannot 
be  proper  assimilation.  Without  assimilation  there  can- 
not be  nutrition.  Without  nutrition  there  cannot  be 
health.'  Moreover,  without  the  retention  and  the  whole- 
some development  of  the  teeth  there  cannot  be  beauty  of 
countenance. 


REFERENCES. 

Ayres,  L.  p.  The  Effect  of  Physical  Defects  on  School 
Progress.  The  Psychological  Clinic,  Vol.  Ill,  No.  3, 
May,  1909,  p.  71. 

Cornell,  Walter  S.  The  Relation  of  Physical  to  Mental 
Defect  in  School  Children.  The  Psychological  Clinic, 
Vol.  I,  No.  9,  February,  1908,  p.  231. 

Mentally  Defective  Children  in  the  Public  Schools.  The 
Psychological  Clinic,  Vol.  II,  No.  3,  May,  1908,  p.  75. 
The  Physical  Condition  of  the  School  Children  of  the 
School  of  Observation,  University  of  Pennsylvania.  The 
Psychological  Clinic,  Vol.  Ill,  No.  5,  October,  1909,  p. 
134. 

The  Need  of  Improved  Records  of  the  Physical  Condi- 
tion of  School  Children.  The  Psychological  Clinic,  Vol. 
Ill,  No.  6,  November,  1909,  p.  161. 


336    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Ebersole.  Report  on  the  Proposed  Dental  Educational  and 
Hygienic  Work  in  the  Cleveland  Schools.  Dental  Sum- 
mary, February  and  March,  1910  (reprinted  in  the 
Dental  Brief  and  Dental  Digest,  same  issue). 

Elson,  W.  H.  Annual  Report  of  the  Superintendent  of 
Schools,  Board  of  Education,  Cleveland,  Ohio,  1907,  p. 
38. 

Emery.  Medical  Inspection  in  Two  Worcester  Schools.  The 
Pedagogical  Seminary,  Vol.  XVII,  No.  2,  April,  1910, 
p.  111. 

Greene,  Mary  Belle.  A  Class  of  Backward  and  Defective 
Children.  The  Psychological  Clinic,  Vol.  Ill,  No.  5, 
October,  1910,  p.  125. 

GuLicK  and  Ayres.     Medical  Inspection  of  Schools,  1913. 

Holmes,  Arthur.  Can  Impacted  Teeth  Cause  Moral  Delin- 
quency? The  Psychological  Clinic,  Vol.  IV,  No.  1, 
March,  1910,  p.  19. 

McHenry.  Medical  School  Inspection  in  Cleveland.  The 
Cleveland  Medical  Journal,  Vol.  VIII,  1909,  p.  338. 

Orr.  The  New  Medical  Inspection  Department  in  the  Cleve- 
land Public  School.  The  Cleveland  Sunday  Leader, 
Magazine  and  Workers'  Section,  March  13,  1910. 

Russell  Sage  Foundation.  What  American  Cities  Are 
Doing  for  the  Health  of  School  Children,  1911. 

Sneed,  C.  M.,  and  Whipple,  G.  M.  An  Examination  of  the 
Eyes,  Ears  and  Throats  of  Children  in  the  Public  Schools 
of  Jefferson  City,  Mo.  The  Psychological  Clinic,  Vol. 
II,  No.  8,  January,  1909,  p.  234. 

Taussig,  A.  E.  The  Prevalence  of  Visual  and  Aural  Defects 
Among  the  Public  School  Children  of  St.  Louis  County, 
Mo.  The  Psychological  Clinic,  Vol.  Ill,  No.  6,  Novem- 
ber, 1909,  p.  149. 


CHAPTER  XVII 

EFFICIENCY  IN   SCHOOL   ORGANIZATION   AND 

THE  CONSERVATION  OF  THE  MENTAL 

HEALTH   OF   CHILDREN^ 

The  preservation  and  promotion  of  the  mental,  physical, 
educational,  social,  moral  and  vocational  efficiency  of  the 
individual  is  not  only  the  most  vital  problem  that  confronts 
each  human  being,  mature  or  immature,  but  it  is  also  the 
problem  par  excellence  of  the  family,  state  and  school. 
Owing  to  the  disintegrating,  and  ofttimes  demoralizing, 
influences  exerted  upon  the  institution  of  the  home  by  the 
modern  urbanization  and  industrialization,  together  with 
the  frequently  attendant  pauperization,  of  a  large  part  of 
our  population,  the  obligation  for  the  reclamation,  conser- 
vation and  Improvement  of  child  life  is  being  largely  trans- 
ferred to  the  state.  But  we  are  rapidly  learning  that  the 
state  has  no  agency  which  is  able  adequately  to  cope  with 
the  numerous  problems  involved  except  the  public  schools. 
And  so  the  obligation  to  care  for  the  welfare  of  the  chil- 
dren is  more  and  more  being  placed  primarily,  and  very 
properly,  upon  the  Institution  of  the  pubhc  schools.  This 
is  the  only  institution  established  under  state  control  in 
all  communities  which  can  be  invested  with  sufficient  police 
power  and  which  commands  In  largest  measure  the 
confidence  of  the  community. 

1  Delivered,  in  part,  at  the  Annual  Meeting  of  the  Child  Study 
Department  of ,  the  Pennsylvania  State  Educational  Association, 
Pittsburgh,  December  31,  1913. 


338    MENTAL  HEALTH  OF  SCHOOL  CHILD 

That  the  pubHc  schools  have  responded  to  the  new 
demands  made  upon  them  by  the  people  during  the  last 
decade  or  two  is  well  known.  They  have  assumed  func- 
tions not  dreamed  possible  only  a  few  years  ago.  Witness 
the  growth  of  the  social  center  or  wider-use-of-the-school- 
plant  movement,  the  establishment  of  evening  continuation 
and  trade  school  work,  the  introduction  of  school  feeding, 
the  organization  of  school  medical  inspection  systems, 
school  medical,  dental  and  psychological  cHnics  and  play- 
grounds and  social  service  departments.  Splendid  as  have 
been  these  recent  attempts  to  reformulate,  revitalize  and 
modernize  the  functions  of  the  schools,  and  wonderful  as 
are  the  results  which  have  already  been  attained,  it  must, 
nevertheless,  be  admitted  that  we  are  even  now  but  in  the 
beginnings  of  the  new  order  of  things — of  a  new  movement 
of  social  and  educational  reconstruction  which  is  destined 
to  sweep  over  all  the  land. 

Among  the  forces  tending  toward  a  more  efficient 
organization  of  school  work  is  the  growing  recognition  of 
the  fact  that  the  basic  condition  of  efficient  instruction  and 
of  the  effective  conservation  of  the  mental  health  and 
special  talents  of  children  is  the  adjustment  of  the  edu- 
cative processes  to  meet  the  varying  needs  of  varying 
children,  and  the  adjustment  of  the  individual  to  his  social 
and  vocational  environment.  Education,  indeed,  is  funda- 
mentally a  process  of  adjustment.  But  only  a  few  of  the 
best  modern  school  systems  (leave  alone  the  average  or 
poor  ones)  have  thus  far  succeeded  in  making  a  measur- 
ably complete  adjustment  of  the  educational  agencies  to 
the  varied  needs  of  'all  the  children  of  the  people,'  and  the 
varied  needs  of  all  the  communities  of  all  the  people.  It 
is  the  purpose  of  this  paper  to  emphasize  the  fact  that 
many,   if  not   most,   of   the   schools   of   the   country   fail 


SCHOOL  ORGANIZATION  339 

properly  to  conserve  the  educational  health  of  all  their 
pupils  because  they  fail  to  adjust  the  processes  of  the 
schools  to  the  individual  requirements  of  the  pupils.  This 
often  renders  much  of  the  work  of  intellectual  and  moral 
instruction  and  training  quite  unscientific,  inefficient  or 
nugatory. 

Before  attempting  to  preach  a  moral,  however,  we 
should  first  be  reasonably  certain  about  our  facts.  Before 
attempting  to  ad\'ise  or  prescribe,  we  should  thoroughly 
scrutinize  the  evidence  and  accurately  diagnose  the  case. 
Only  after  the  existence  of  defects  in  the  existent  social, 
educational,  or  industrial  order  has  been  proved,  is  the 
critic  or  advocate  ready  for  the  public  forum,  and  only 
then  will  he  receive  the  critical  attention  and  arouse  the 
determined  action  of  thoughtful  people.  It  was  the  expos- 
ure of  the  demonstrated  existence  of  repellent  conditions 
in  the  Chicago  slaughter-houses  and  stock-yards  that  led 
to  the  enactment  of  meat  inspection  laws.  It  was  the  high 
degree  of  refinement  and  differentiation  of  medical  diag- 
nosis that  led  to  speciaHzation  in  medicine,  to  the  develop- 
ment of  various  kinds  of  medical  specialists,  and  which 
made  imperative  the  organization  of  various  kinds  of  hos- 
pitals and  the  differentiation  of  wards  and  clinics  within 
hospitals.  Just  so  surely  as  the  refinement  of  scientific 
medical  diagnosis  has  led  to  the  development  of  new 
specialties  in  medicine,  which  has  resulted  in  the  improved 
differential  remedial  treatment  of  sick  people,  so  surely 
will  the  refinement  of  scientific  educational  diagriosis 
develop  new  specialties  and  new  methods  of  treatment  in 
education.  One  of  the  peculiar  benefits  of  this  advance 
step,  toward  which  education  is  surely  tending,  is  that  the 
schools  (hke  the  hospitals  in  respect  to  medical  care)  will 
develop  differential  or  remedial  or  corrective  educational 


340    MENTAL  HEALTH  OF  SCHOOL  CHILD 

treatment  designed  to  meet  the  individual  needs  of  all 
those  children  who  differ  from  the  standard  of  mental  and 
pedagogical  health  in  the  same  sense  that  different  kinds 
of  sick  persons  differ  from  the  standard  of  bodily  health. 
When  our  schools  have  been  organized  scientifically  to 
diagnose  educationally  abnormal  pupils  as  hospitals  are 
now  organized  to  scientifically  diagnose  sick  people,  then, 
and  then  only,  will  the  schools  be  prepared  intelligently 
maximally  to  conserve  and  to  improve  the  mental,  educa- 
tional, moral  and  physical  well-being  of  all  the  children, 
and  economically  and  efficiently  to  train  them  for  the 
social,  civic  and  vocational  responsibilities  for  which  they 
are  fitted.  Then,  and  then  only,  will  the  work  of  rearing 
children  be  made  as  dignified  and  as  scientific  as  the  work 
of  raising  cattle  and  horses.  Then,  and  then  only,  will 
school  supervision  be  made  efficient,  and  school  organiza- 
tion minister  effectually  to  the  needs  of  all  the  children. 
But  I  have  anticipated  my  conclusions  in  the  preamble. 
I  must  therefore  proceed  at  once  to  present  some  facts  to 
justify  the  above  assertions,  which  may  sound  to  you  like 
the  'pipe-dreams'  of  a  beclouded  mind.  What  you  demand 
are  actual  concrete  facts — facts  which  are  capable  of 
duplication  and  verification  in  any  large  school  system 
anywhere.  Nowhere  are  such  facts — abundant,  verifiable, 
incontestable — more  easily  accessible  than  in  the  clinic  files 
of  the  modern  well-organized  psycho-educational  clinic. 
The  facts  now  to  be  presented  consist  of  a  dozen  clinical 
pictures  selected  from  the  files  of  the  educational  clinic  in 
the  School  of  Education  of  the  University  of  Pittsburgh. 
These  pictures  fail  to  furnish  an  adequate  idea  of  the  great 
variety  of  educationally  unusual  children — some  easily 
diagnosed  and, others  extremely  baffling — which  have  been 
coming  to  the  clinic  for  examination  from  various  sections 


SCHOOL  ORGANIZATION  341 

in  Western  Pennsylvania.  However,  the  cases  discussed 
will  not  only  furnish  clinical  pictures  of  the  two  opposite 
types  of  educational  deviates — the  subnormal  and  the 
supernormal — but  they  will  also  give  a  faint  idea  of  the 
great  variety  of  subtypes  of  abnormal  children  which  will 
be  found  within  any  given  classification,  or  within  the  same 
grade  of  mental  arrest  or  acceleration,  and  which  must  be 
adequately  differentiated  unless  the  public  will  continue 
to  be  satisfied  with  the  type  of  crude  and  amateurish 
educational  diagnosis  which  is  now  tolerated  in  most 
school  systems. 

I  shall  begin  with  the  subnormal  cases,  using  the  word 
subnormal  in  its  broadest  connotation,  as  inclusive  of  all 
cases  on  the  minus  side  of  the  curve  of  distribution.  I 
shall  first  present  five  types  of  imbeciles,  pointing  out  the 
moral  for  the  schools  and  for  the  community  in  connection 
with  the  discussion  of  each  case.  It  is  well  to  dwell  on  these 
cases  for  two  reasons :  first,  because  it  sometimes  happens 
that  these  cases  never  get  to  the  schools  and  therefore 
receive  no  educational  attention  whatsoever ;  second — 
and  this  happens  more  frequently — because  all  types  and 
grades  of  imbeciles  actually  do  get  to  the  schools,  and 
when  there  they  are  scarcely  ever  recognized  by  the 
teachers,  principals,  nurses  or  school  inspectors,  unless 
teachers  and  inspectors  have  taken  special  courses  on 
feeble-minded  and  backward  children.  The  claim  has 
frequently  been  made,  and  presumably  still  is  made,  in  all 
sections  of  the  country  by  teachers,  superintendents  and 
medical  inspectors  that  cases  so  low-grade  as  imbeciles, 
particularly  the  low-grade  imbeciles,  never  get  into  the 
schools.  We  now  know  that  this  statement  is  without 
foundation.  I  shall  first  cite  two  cases,  however,  which  did 
not  receive  any  school  instruction. 


342    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Case  1 

My  first  case  is  an  Irish-American  girl,  aged  eleven 
years  eleven  months  at  the  time  of  the  clinic  examination 
in  November,  1913. 

She  is  reported  to  have  been  'a  fine,  healthy  babe/ 
weighed  twelve  pounds  at  birth,  nursed  for  one  and  a  half 
years.  Cerebro-spinal  meningitis,  accompanied  by  con- 
vulsions at  the  time  of  teething  during  the  tenth  month, 
left  her  sickly,  fretful  and  backward.  The  first  teeth 
did  not  'come  through'  until  the  age  of  two  and  a  half 
and  the  second  set  began  cutting  during  the  tenth  year. 
The  anterior  fontanelle  did  not  close  until  about  three. 
At  three  she  was  too  weak  to  walk,  stumbling  and  falling, 
but  walked  unsupported  at  about  the  age  of  four;  the 
control  of  the  fundamental  reflexes  was  acquired  at  about 
four.  Measles  at  four  and  a  light  attack  of  pertussis, 
and  scarlet  fever,  at  five.  Speech  has  remained  unde- 
veloped except  for  very  few  words  and  various  inarticu- 
late sounds  (nuh=no;  uh-huh=:yes  lah^ Jennie,  her 
sister;  nah=:her  usual  response). 

Eats  heartily  and  sleeps  soundly  at  present.  Table 
manners  good  but  cannot  sip  soup ;  drinks  it  and  slobbers 
on  clothes.  Usually  good-natured,  but  has  spells  of  stub- 
bornness, displays  violent  temper  when  aroused  and  will 
chase  boys  on  the  street  who  annoy  her. 

Home  conditions  and  home  treatment  fair.  Is  able  to 
scrub  floor,  iron  dust-cloths,  sew  fairly  well,  dress  herself, 
but  cannot  button  her  clothes  or  wash  her  face  clean  or 
go  errands.     She  cannot  persist  in  her  work. 

The  clinic  examination  disclosed  the  presence  of  several 
dental  cavities  and  strabismus  due  to  muscular  paralysis. 
Dental  treatment  was  advised  and  has  been  provided. 

In  anthropometric  development^  she  was  quite  normal. 
-  In  all  cases  the  anthropometric  measurements  are  compared  with 
the  norms  furnished  by  Smedley   (percentile  and  age  tables),  Boas, 


SCHOOL  ORGANIZATION  343 

In  standing  and  sitting  height,  head  circumference  and 
weight  she  was  equal  to  the  normal  twelve-year-old  girl, 
while  in  strength  of  right-hand  and  left-hand  grip  she 
ranked  between  nine  and  ten  and  ten  and  eleven,  respec- 
tively. Her  weight  was  correct  for  her  height  and  the  pro- 
portion between  standing  and  sitting  stature  was  also 
right  ( ponder al  index  equals  23.1,  normal  equals  23.3; 
statural  index  equals  53.2,  normal  equals  53.2). 

But  mentally  she  tested  only  to  about  the  age  of  three, 
while  in  motor  development  she  was  like  a  child  of  four. 

She  was  unable  to  copy  a  square,  could  not  show  her 
right  hand  and  left  ear  except  in  a  vaccillating  manner, 
could  not  state  the  number  of  fingers  on  the  two  hands, 
but  was  sometimes  able  to  hold  up  as  many  fingers  as  the 
number  of  fingers  held  up  by  the  examiner.  When  shown 
a  key  and  asked  what  it  was  she  picked  a  key  from  her 
mother's  handbag.  Cannot  distinguish  between  pretty 
and  ugly  pictures  or  execute  a  triple  order,  is  sensitive  to 
the  presence  of  observers,  but  makes  fair  effort  to  respond 
and  some  effort  to  talk. 

Here  is  afforded  a  very  interesting  case  of  partial 
aphasia  superposed  upon  a  background  of  imbecility  of 
developmental  origin  (due  to  inflammation  of  the  pia 
mater),  with  practically  normal  anthropometric  develop- 

Hastings,  Qu6telet  and  Montessori.  The  norms  from  these  authori- 
ties are  sometimes  discrepant,  whence  it  has  at  times  been  necessary 
to  make  approximations.  In  all  cases  the  intellectual  age  has  been 
determined  by  the  Binet-Simon  scale,  1908  edition,  the  author's  guide 
(Experimental  Studies  of  Mental  Defectives,  Baltimore,  1912,  pp. 
116f.).  The  motor  age  has  been  determined  by  the  Vineland  form- 
board.  Data  are  also  given  for  the  two  Healy-Fernald  construction 
puzzles  (Tests  for  Practical  Mental  Classification,  Baltimore,  1911. 
It  has  not  yet  been  proved  that  these  construction  puzzles  have  the 
value  for  mental  diagnosis  claimed  for  them.  I  ha%^e  a  number  of 
instances  where  the  child  failed  utterly  to  do  the  tests  on  one  occasion 
but  had  no  difficulty  on  another  occasion.  The  outcome,  apparently, 
depends  too  much  on  chance). 


344    MENTAL  HEALTH  OF  SCHOOL  CHILD 

ment.  Although  almost  twelve  years  of  age,  this  child 
has  never  received  any  systematic  instruction  either  at 
home  or  in  school.  The  educational  possibiHties  of  a  case 
like  this  are,  to  be  sure,  quite  limited.  But  corrective 
speech  work,  applied  several  years  ago,  would  not  have 
been  entirely  futile,  and  the  right  kind  of  sensori-motor 
training  would  have  developed  a  degree  of  motor  skill 
which  would  now  enable  this  girl  to  make  more  profitable 
use  of  muscles  which  are  not  very  far  below  normal 
strength.  The  time  almost  invariably  comes  in  the  lives  of 
these  unfortunates  when  society  must  support  them,  and  it 
is  only  a  just  demand  of  society  that  the  schools  so  train 
them  in  their  youth  that  they  may  be  able  to  contribute 
more  to  their  own  support  in  institutions  than  they  can  do 
if  left  to  grow  up  untrained  in  their  homes. 

Case  2 

The  following  case,  an  American  gii'l,  age  sixteen  years 
eleven  months  at  the  time  of  the  examination  in  December, 
1912,  grades  about  the  same  in  intelligence,  but  represents 
a  different  type.  She  furnishes  another  illustration  of 
educational  neglect. 

According  to  the  record,  her  birth  was  normal  and  on 
time,  weighed  about  eight  pounds  at  birth,  bottle  fed, 
appeared  bright  and  intelligent  as  a  babe  but  did  not 
kick  like  the  normal  child;  six  or  eight  teeth  appeared 
simultaneously  during  the  sixth  month;  walked  at  about 
the  age  of  two  but  required  braces  until  three;  began  to 
talk  more  or  less  at  three  or  four.  Mental  peculiarity  first 
noticed  by  parents  at  six  years,  particularly  the  lack  of 
progress  in  speech  development.  Pubertal  development 
somewhat  retarded  (first  menstruation  at  fifteen  and  one 
half  years). 


SCHOOL  ORGANIZATION  345 

Chicken-pox,  mumps  and  measles  during  fourth  year; 
scarlet  fever,  followed  by  diphtheria,  rendered  the  child 
weak  for  five  or  six  weeks.  Always  more  or  less  nervously 
unstable,  easily  excited,  'nervous  jumps,'  but  without 
violent  outbreaks. 

At  home,  she  is  amiable  and  obedient,  understands 
commands  and  is  willing  to  do  what  she  can  compre- 
hend. Can  sweep,  scrub,  set  table,  put  on  shoes  and 
stockings.  Does  not  know  the  alphabet  nor  understand 
the  meaning  of  such  words  as  'or'  and  'if,'  and  cannot 
read  or  count. 

Mother  very  weak  and  nervous  before  child's  birth; 
father  not  always  temperate;  one  cousin  of  father  'weak- 
minded';  a  child  of  father's  sister  'acted  peculiarly'  and 
could  not  talk;  a  child  of  the  daughter  of  a  sister  of  the 
father  had  chorea. 

Attended  school  a  few  days  at  the  age  of  six,  but  was 
sent  home  because  she  was  'too  nervous.'  No  other 
schooling. 

The  examination  at  the  clinic  revealed  an  excitable 
but  pleasant  type  of  imbecile,  with  pronounced  neurotic 
stigmata,  gross  finger  twitches,  occasional  nervous  starts, 
two  slightly  enlarged  tonsils,  two  carious  teeth,  an 
asymmetrical  chest  and  a  very  unsymmetrical  physical 
development.  In  head  girth,  she  graded  eight  years,  in 
standing  and  sitting  height,  over  eighteen  years  (statural 
index  equals  52.7,  normal  equals  52)  ;  in  weight,  a  little 
over  fifteen  (ponderal  index  equals  22.7,  normal  equals 
23.6)  ;  in  strength  of  grip,  about  normal,  but  in  vital 
capacity  notably  deficient.  She  is  thus  both  too  tall 
and  too  light  and  her  head  is  exceptionally  small.  Her 
speech  was  very  indistinct;  she  was  color  blind  and  pos- 
sessed very  little  comprehension  of  form. 

Intellectually,  she  tested  at  about  three  and  a  half 
years. 


346    MENTAL  HEALTH  OF  SCHOOL  CHILD 

She  knows  the  value  of  the  four  smallest  United  States 
coins,  can  point  to  her  nose,  eyes  and  mouth,  names  a 
knife  and  a  key,  knows  her  sex  and  can  distinguish  the 
difference  in  weight  between  six  and  fifteen  grams.  She 
can  repeat  only  the  last  of  two  digits  or  the  last  word  of 
six  syllables  pronounced  to  her^  says  she  has  two  fingers 
on  her  right  hand,  makes  no  reply  for  the  left,  and  two 
fingers  on  both  hands. 

This  girl  had  been  examined  repeatedly  during  the  last 
ten  years,  but  the  mother  had  never  yet  been  told  what  was 
fundamentally  wrong  with  her — a  low  degree  of  imbecility 
of  the  simple  and  excitable  type,  probably  of  combined 
primary  and  secondary  origin. 

Because  the  girl  was  able  to  understand  a  little  and  do 
a  few  things,  the  mother  had  been  permitted  to  continue 
to  indulge  the  fond,  but  vain,  belief  that  she  would  some 
day  'grow  out  of  it.'  She  was,  however,  assured  at  the 
clinic  that  her  girl  will  never  advance  beyond  a  child  of 
four  or  five,  that  she  will  need  lifelong  protection, 
especially  against  the  exploiters  of  defenseless  girls  of  her 
type,  and  that,  as  she  had  already  passed  the  pubertal 
epoch,  she  should  be  given  the  protection  of  institutional 
care,  especially  if  such  protection  could  not  be  guaranteed 
at  home.  As  a  result  of  this  advice,  appUcation  was  filed 
about  a  year  ago  for  her  admission  into  the  state  institu- 
tion at  Polk,  but  it  has  thus  far  been  impossible  to  get 
her  admitted. 

In  theory,  the  public  schools  should  not  be  required  to 
train  any  child  below  the  level  of  high-grade  imbecile.  In 
practice,  however,  they  are  forced  to  accept  these  children, 
unless  society  is  satisfied  to  have  them  idle  their  time  away 
in  the  homes  or  roam  the  streets,  as  so  many  do,  and  drift 
into  vagabondage,  prostitution  and  criminality.     No  state 


1 


SCHOOL  ORGANIZATION  347 

in  the  union  has  sufficient  institutional  provisions  to  accom- 
modate 25  per  cent  of  all  its  feeble-minded  children. 
Moreover,  many  parents,  owing  to  the  sympathy  which 
they  feel  for  their  unfortunate  progeny,  refuse  to  insti- 
tutionalize them  (and  will  not  do  so  in  the  absence  of 
mandatory  laws),  and  cannot  reconcile  themselves  to 
allowing  them  to  remain  in  institutions  even  after  they 
have  been  admitted.  This  may  be  illustrated  by  the 
following  case  who  was  admitted,  after  special  pleadings 
had  been  made,  to  the  state  institution. 

Case  3 

A  boy,  aged  nine  years  ten  months  at  the  time  of  the 
examination  in  May,  1913. 

The  record  indicated  that  the  child  was  born  normally ;, 
the  last  of  eight  children  from  the  second  husband;  age 
of  mother  and  father  at  the  time  of  child's  birth  forty- 
two  and  forty-eight,  respectively.  He  was  unable  to 
nurse  after  the  eighth  week,  thenceforth  bottle  fed; 
developed  'catarrh'  from  cold  contracted  during  the  third 
week;  nose  operation  at  one  and  a  half  years,  nasal 
obstruction  removed  at  two  and  a  half;  same  operation 
repeated  in  the  same  nostril  at  three  and  a  half;  nose 
operation  again  in  November,  1911.  Has  been  examined 
again  and  again,  but  mother  has  never  been  told  that 
there  was  anything  wrong  except  nasal  obstruction, 
catarrh  and  adenoids.  Fell  on  the  forehead  at  one  and  a 
half  years ;  mumps  at  four,  typhoid-pneumonia  at  five, 
scarlet  fever  at  five  and  a  half;  frequently  suffered  from 
styes;  has  been  subject  to  enuresis.  The  mental  pecu- 
liarity (slow  development)  was  noticed  by  the  mother 
between  the  first  and  second  years. 

Restless  and  active  in  disposition,  always  doing  some- 
thing.     Enjoys   roller-skating.      Able  to   dress   and   feed 


348    MENTAL  HEALTH  OF  SCHOOL  CHILD 

himself.  Bad  temper  at  times,  but  obedient  if  taken  in 
right  way. 

Started  to  kindergarten  at  five  and  a  half ;  at  seven,  was 
placed  in  the  first  grade,  but  was  soon  returned  to  kinder- 
garten; at  eight,  was  again  advanced  to  first  grade,  where 
he  went  over  the  first  half  year's  work  three  or  four 
times  with  as  many  different  teachers ;  then  was  advanced 
to  lA;  he  learned  to  write  his  name  and  a  few  words, 
although  they  meant  nothing  to  him;  but  could  not  learn 
to  count. 

The  clinic  examination  revealed  a  diminutive,  restless 
type  of  boy,  crying  because  he  was  afraid  his  nose  would 
be  operated  on,  suffering  from  rhinitis,  pharyngitis  and 
running  ears ;  he  had  a  tongue  slightly  fissured  trans- 
versely, stubby  fingers,  with  the  little  finger  somewhat 
inturned,  rather  sandy  hair,  a  rounded,  diminutive  head, 
with  a  girth  less  than  for  a  six-year-old  boy.  In  standing 
height  and  weight  he  had  a  development  of  seven  and  a 
half  years,  in  sitting  height  six  and  a  half,  in  hand  grip 
between  eight  and  nine  for  the  right  hand  and  about  nine 
for  the  left  hand.  Thus  in  physical  development  he 
ranges  from  the  child  of  six  to  seven  and  a  half,  while 
his  manuometry  is  about  normal.  Relatively  to  total 
stature  his  trunk  is  too  short,  but  his  weight  is  about  right 
(statural  index  equals  63.2,  which  is  about  normal  for 
age  twelve;  ponderal  index  equals  23.7,  normal  equals 
23.5). 

At  the  age  of  nearly  ten  years  he  had  an  intelligence  of 
only  four  and  a  half  years,  which  is  less  than  the  intelli- 
gence he  should  have  had  when  he  first  entered  the  first 
grade.  His  motor  development  was  even  less,  namely,  four 
years.  His  mental  development  is  thus  from  two  to  three 
years  inferior  to  his  physical  development. 

He  is  unable  to  repeat  three  numbers  or  six  syllables ; 
does  not  know  which  is  his  right  hand  and  left  ear,  says 


SCHOOL  ORGANIZATION  349 

he  has  three  fingers  on  the  right,  four  on  the  left  and  six 
fingers  on  both  hands;  says  he  is  seven  years  old,  cannot 
distinguish  pretty  from  ugly  faces,  cannot  state  whether 
the  time  of  the  day  is  forenoon  or  afternoon,  or  copy  a 
diamond  or  square,  or  locate  missing  parts  in  pictures. 
Says  a  horse  is  a  horse,  a  dog  is  a  dog,  mamma  is  a 
mother,  a  table  is  'table  cover,'  a  chair  is  'make  one  table 
chair.'  Calls  a  quarter  five  cents,  names  red  and  blue 
correctly,  but  calls  green  blue  and  yellow  red;  says  three 
two  and  three  one  cent  stamps  are  eight  stamps  and  cost 
ten  cents.  Is  able  to  read  such  monosyllables  as  'in,'  'it' 
'to.' 

This  child  is  a  mongolian  imbecile,  although  not  so 
easily  recognized  as  such  because  of  the  attenuation  of 
the  mongoloid  characteristics.  Mongolian  defectives 
unusually  attain  a  mentality  of  about  five  years,  rarely 
falling  below  four  or  exceeding  seven.  They  usually  come 
from  the  later  pregnancies  of  parents  of  between  forty 
and  fifty  of  good  hereditary  qualities.  Another  boy  with 
glaringly  obvious  mongolian  features,  six  years  old,  who 
was  more  recently  examined  at  the  cKnic,  had  a  mentality 
of  about  two  years  and  was  the  tenth  of  a  family  of 
fourteen  children.  He  had  been  examined  more  than  a 
dozen  times  and  had  been  treated  for  all  kinds  of  troubles, 
but  the  mother  had  never  been  told  before  that  he  was  an 
incurable  mongolian  imbecile.  It  is  very  important  to 
recognize  this  type  early  for  two  reasons :  first,  because 
these  children  are  naturally  affectionate  and  agreeable 
when  understood  and  properly  treated,  but  quite  mis- 
chievous, stubborn  and  irascible  when  not  understood. 
Unfortunately  they  are  rarely  understood  in  the  home, 
school  or  on  the  playground,  where  they  are  teased  and 
bullied.     Second,  because  they  require  differential  educa- 


350    MENTAL  HEALTH  OF  SCHOOL  CHILD 

tional  treatment  in  special  classes.  It  is  a  waste  of  time 
to  try  to  train  these  children  to  read,  write  and  cipher, 
while  speech  training  yields  very  meager  results  because 
of  their  limited  intelhgence.  They  should  be  trained  in 
simple  domestic  and  industrial  tasks  which  do  not  entail 
very  much  strain  on  their  vascillating  attention.  The 
proper  place  to  train  them  is  in  state  institutions,  but 
unfortunatel}'^,  as  has  been  said,  it  is  difficult  to  persuade 
the  parents  to  part  with  them  while  they  are  young  and 
plastic  and  to  keep  them  in  commitment  once  they  are 
admitted.  Case  3  was  admitted  to  the  state  institution  at 
Polk  in  August,  1913,  but  was  removed  after  only  three 
weeks  of  residence  by  his  mother.  Until  we  have  mandatory 
commitment  laws  the  public  schools  will  be  obliged  to  train 
low-grade  defectives.  But  they  should  under  no  circum- 
stances be  permitted  in  the  regular  classes,  there  to  waste 
their  years  on  work  which  has  utterly  no  meaning  or  value 
for  them,  there  to  monopoUze  the  time  of  the  teacher  (but 
some  teachers,  I  have  found  from  first-hand  reports, 
ignore  them  and  let  them  sit  idle),  and  there  to  rob  the 
normal  and  bright  pupils  of  the  advantages  which  by 
right  are  theirs.  It  looks  almost  like  criminal  negligence 
on  the  part  of  the  school  administration  to  have  kept  this 
child  two  or  three  years  in  the  first  grade.  There  is  a  fine 
irony  in  calling  education  an  art  based  on  scientific 
principles  so  long  as  this  state  of  affairs  is  permitted  to 
continue  in  the  public  schools.  Some  types  of  defectives, 
it  is  true,  cannot  be  infallibly  diagnosed  at  four  or  five 
years  of  age  because  the  deficiency  accumulates  gradually 
and  is  not  very  patent  at  four  or  five,  but  not  so  with  this 
type  of  defective. 

To  what  an  extent  the  public  schools  are  wasting  the 
people's  funds — of  course  not  intentionally,  but  because 


SCHOOL  ORGANIZATION  351 

of  the  failure  to  provide  the  means  for  scientifically  classi- 
fying pupils — by  trying  to  train  in  the  regular  classes 
both  low-  and  high-grade  defectives  will  appear  from  a 
consideration  of  the  following  high-grade  imbeciles. 

Case  4 

An  American  boy,  aged  eleven  years  eleven  months  at 
the  time  of  the  examination  in  December,  1913. 

From  his  history  we  learned  that  he  was  the  fifth  born 
of  nine  children^  two  of  whom  died  in  infancy;  he  was 
diminutive  at  birth,  bottle  fed  for  one  and  a  half  years, 
unable  to  sit  up  until  one  and  a  half,  unable  to  walk  until 
three,  although  he  is  reported  as  talking  at  about  two ; 
neglected,  poorly  nourished  and  puny  as  a  babe. 

The  present  home  conditions  are  reprehensible  from 
the  hygienic,  sanitary  and  moral  points  of  view.  A  four- 
room  tenement  house,  lacking  a  bath  and  abounding  in 
dirt  and  vermin,  in  a  densely  populated  section,  is  occu- 
pied by  ten  persons.  Seven  children  sleep  in  a  small, 
unventilated  bedroom,  three  boys  in  one  bed  and  four 
girls  in  another.  The  food  supply  is  inadequate  in  quan- 
tity and  quality.  The  home  life  is  upset  and  disturbed 
and  the  children  are  neglected  and  poorly  disciplined. 
This  boy  spends  much  of  his  time  roving  around  and 
playing  in  the  streets. 

The  father,  now  a  bookkeeper  and  apparently  a  drug 
fiend,  formerly  held  an  educational  position  in  a  higher 
institution  of  learning  in  the  state  of  Pennsylvania,  and 
springs  from  a  stock  having  several  illustrious  names  to 
its  credit.  The  mother  was  subject  to  scrofula  during 
the  first  sixteen  years  of  her  life,  and  apparently  is  of 
inferior  stock. 

The  boy  entered  school  at  six,  has  been  very  irregular 
in  attendance  and  is  reported  as    a  'total  failure,'  poor  in 


352    MENTAL  HEALTH  OF  SCHOOL  CHILD 

all  branches,  but  best  in  music.  At  twelve  he  can  count 
to  ten,  but  cannot  add,  multiply,  divide  or  subtract,  can- 
not read  or  spell,  is  very  poor  in  writing  and  spelling, 
and  at  the  end  of  fifty-three  months  of  schooling  he  is 
still  in  a  regular  first-grade  class.  The  school  report 
indicates  that  he  is  chatty,  sociable,  good-natured,  kind, 
cheerful,  impulsive,  but  also  restless,  nervous,  at  times 
excitable  with  outbreaks  of  laughing  or  of  destructive 
tendencies.  He  inclines  to  be  heedless  of  reproof, 
although  he  takes  reproof  with  good  grace,  and  is  like- 
wise heedless  of  danger.  He  is  careless,  slovenly  and 
'acts  like  an  old  man  of  seventy.' 

The  examination  at  the  clinic  revealed  a  poorly  nour- 
ished child  with  eight  dental  caries,  two  enlarged  tonsils 
(for  which  dental  and  medical  care  was  recommended, 
but  nothing  has  thus  far  been  done  owing  to  the  indiffer- 
ence of  the  father),  and  an  anthropometric  development 
ranging  from  about  five  to  seven  years.  His  standing 
stature  was  nearly  equal  to  seven,  his  bust,  weight  and 
vital  capacity  nearly  equal  to  six  and  a  half,  and  his  head 
girth  less  than  five.  On  the  other  hand,  in  strength  of 
grip  he  ranged  between  eight  and  nine  years,  and  his 
weight  was  about  right  for  his  stature  (although  the 
ponderal  index  was  23.2  instead  of  22.8,  normal  for 
height),  but  his  bust  was  too  long  (index  of  stature 
equals  55  instead  of  53;  brachyscelous  type).  No  one  of 
his  two  sisters  and  his  two  brothers,  varying  in  ages 
from  eight  to  fourteen  years,  who  were  examined  in  the 
clinic,  had  a  head  girth  equal  to  the  normal  seven-year- 
old  child,  while  the  average  for  all  the  five  cases  was  less 
(19.5  inches)  than  for  the  five-year-old  boy  or  girl. 

In  the  clinic,  on  superficial  examination,  he  appeared 
bright,  but  with  a  highly  distractable  attention,  his 
speech  was  distinct,  fluent,  but  also  glib,  and  he  took 
delight  in  talliing  about  his  interests  and  in  narrating  his 


I 


SCHOOL  ORGANIZATION  353 

possible  and  impossible  experiences — among  others  that 
on  hallowe'en  he  had  dressed  up  and  pointed  a  make- 
believe  revolver  at  a  man^  securing  from  him  twenty 
dollars,  which  he  had  deposited  in  his  bank  at  home. 

His  intellectual  age  was  only  about  six  years,  while 
his  motor  development  was  about  seven  and  a  half.  In 
this  case  there  is  a  fair  correspondence  between  the 
physical  and  mental  retardation. 

He  said  he  had  ten  fingers  on  the  right  hand,  eight  on 
the  left  and  two  hundred  on  both  hands ;  thirteen  pennies 
were  counted  as  seventeen;  nine  cents'  worth  of  stamps 
cost  fifty-two  cents;  'in'  was  read  as  'it,'  'bed'  as  'ed' 
while  'to'  was  read  correctly;  he  was  unable  to  write  from 
dictation,  to  count  backwards,  to  state  the  difference 
between  common  concepts,  to  select  in  order  five  weights 
differing  by  three  grams,  or  to  give  descriptive  definitions. 
Monday,  October  13,  1913,  was  said  to  be  'Monday,  May 
34,  second  year.'  He  named  the  four  smallest  coins, 
recognized  the  four  fundamental  colors  and  repeated  the 
week  days  correctly. 

This  boy  is  a  perfectly  typical  quasi-microcephalic, 
unstable,  high-grade  imbecile  of  congenital  origin,  whose 
condition  is  possibly  aggravated  by  insufficient  feeding  and 
bad  home  conditions ;  but  after  five  years  of  schooling  in 
the  same  grade  he  was  not  recognized  by  the  school  force 
as  a  true  imbecile,  but  only  as  a  case  of  marked  stupidity 
or  backwardness,  complicated  with  a  certain  degree  of 
waywardness.  For  over  five  years  he  has  been  permitted 
to  mark  time  in  the  regular  grades,  but  has  practically 
nothing  to  show  for  his  years  of  toil  and  trouble,  the 
teacher's  labors  have  accomplished  merely  negligible 
results,  and  the  schools  have  wasted  for  the  instruction  of 
this  boy  alone  at  least  $150  of  the  taxpayers'  money  in  the 
vain  attempt  to  educate  an  imbecile  as  if  he  were  a  normal 


354    MENTAL  HEALTH  OF  SCHOOL  CHILD 

child.  It  is  almost  incomprehensible  that  we  should  toler- 
ate in  this  day  of  scientific  efficiency  such  wasteful  expendi- 
tures of  the  public  funds  in  the  education  of  misfit  pupils 
in  the  regular  grades.  This  boy,  at  the  very  beginning 
of  his  school  career,  should  have  been  given  an  educational 
examination  by  a  competent  educational  examiner,  supple- 
mented by  a  medical  examination,  and  then  should  have 
been  assigned  to  a  special  class.  The  teaching  of  reading, 
writing,  language  and  arithmetic  by  ordinary  methods  is 
unavailing  for  all  imbeciles  and  for  most  morons.  Taught 
the  things  they  are  able  to  master,  imbeciles  can  be  made 
measurably  efficient  in  the  very  humble  tasks  of  life. 

Incidentally  I  may  say  that  the  school  records  of  the 
five  children  from  this  family  examined  in  the  clinic  are 
one  series  of  failures.  In  the  aggregate,  these  children 
have  spent  24.5  years  in  school,  but  have  completed  only 
12  years  of  work.  They  have  thus  repeated  at  least  12 
years.  Since  the  cost  of  instruction  for  each  grade  pupil 
in  the  schools  of  this  system  amounts  to  $30  a  year,  the 
economic  loss  to  the  community  amounts  to  $360.  This, 
of  course,  does  not  include  the  added  outlay  required  to 
provide  equipment  and  seating  for  these  repeaters,  nor 
does  it  include  the  educational  and  economic  loss  which 
the  community  ultimately  must  suffer  from  allowing 
deficient  children  to  continue  in  the  regular  classes  where 
they  monopolize  the  teacher's  time  and  impede  the  prog- 
ress of  the  normal  pupils.  And  this  family  is  only  one 
among  scores  of  similar  or  worse  families  in  the  same 
community.  Witness  the  following  record  from  another 
school  of  another  group  of  five  children  from  two  related 
families,  all  of  whom  were  examined  in  the  clinic.  One  of 
the  mothers  was  kidnaped  at  thirteen  by  her  uncle,  with 
whom  she  subsequently  lived  without  being  married  to  him, 


SCHOOL  ORGANIZATION  355 

and  by  whom  she  was  infected  with  venereal  disease. 
Fortunately  only  three  of  her  eighteen  children  survive. 
The  other  woman  also  lived,  without  being  married,  with 
her  uncle,  a  brother  of  the  former  man.  Both  men  deserted 
the  mothers  of  their  children.  From  these  unholy  alliances 
have  issued  two  boys  with  immoral  tendencies,  and  one  boy 
was  at  one  time  confined  to  an  institution  for  the  mentally 
disordered.  The  five  school  children  (having  an  average 
head  girth  of  only  19.9  inches,  or  about  the  same  as  the 
five  children  from  the  other  family)  have  spent  29.5  years 
in  the  regular  classes,  but  have  completed  only  ten  grades, 
thus  having  repeated  fully  19  years  of  work  at  a  cost  for 
wasted  instruction  alone  of  $570.  If  the  school  efficiency 
expert  wants  proof  of  inadequacy  in  the  organization  of 
public  school  instruction  let  him  turn  to  the  files  of  a 
modern  psycho-educational  clinic,  where  he  will  find 
evidence  galore  of  wasted  educational  endeavor  and  mis- 
spent funds.  And  for  this  state  of  affairs  the  intelligent 
public  is  itself  to  blame.  I  feel,  however,  that  just  so  soon 
as  the  facts  regarding  the  educational  waste  due  to  faulty 
organization  of  class  instruction  are  fully  realized  by  the 
public,  every  large  school  system  will  be  forced,  on  purely 
economic  if  not  educational  or  humanitarian  grounds,  to 
employ  the  services  of  expert  educational  examiners  to 
properly  classify  and  direct  the  education  of  all  mentally 
unusual  children.  Let  me  emphasize  that  the  quality  of 
the  total  output  of  the  schools  will  always  depend  very 
largely  on  the  ascertainment  of  the  individual  peculiari- 
ties and  needs  of  the  pupils.  But  if  the  schools  are  under 
obligation  to  provide  the  type  of  classes  and  instruction 
which  will  conserve  the  mental  health  of  special  children, 
the  obligation  of  the  state  is  equally  clear.  The  state 
must  take  steps  to  prevent  the  formation  of  families  of  this 


356    MENTAL  HEALTH  OF  SCHOOL  CHILD 

type.  The  schools  must  do  their  duty  by  the  children 
already  born;  but  society  must  cut  off  the  sources  of 
supply. 

Case  5 

My  next  case,  a  boy  of  eleven  at  the  time  of  the  exami- 
nation in  January,  1913,  represents  an  extremely  variable 
type  of  children,  90  per  cent  of  whom  stop  short  very  early 
in  their  mental  development,  many  of  whom  make  Httle  or 
no  progress  in  school,  tending  rather  to  dement  as  they 
advance  in  years,  many  of  whom  manifest  more  or  less 
frequent  fluctuations  in  working  capacity,  and  very  few  of 
whom  should  ever  be  permitted  in  the  regular  classes,  not 
only  because  they  require  a  special  educational  regimen 
but  because  their  unpredictable  paroxysmal  outbreaks  tend 
to  frighten  normal  children  and  upset  the  order  of  the 
entire  classroom. 

The  record  indicates  that  the  boy  was  the  fifth  child, 
born  normally,  at  birth  weighed  from  seven  to  seven  and 
one-half  pounds,  delicate  and  very  cross  as  a  babe, 
suffered  from  indigestion,  did  not  increase  properly  in 
weight,  dentition  delayed  until  the  second  year,  did  not 
walk  or  talk  until  about  the  third  year.  Membranous 
croup  and  measles  between  the  third  and  fourth  year;  the 
victim  of  many  accidents ;  was  rim  over  by  vehicles  but 
never  severely  hurt ;  several  falls ;  at  about  the  age  of  six 
fell  from  the  barn,  cutting  his  head.  At  about  nine,  he 
developed  diurnal  and  nocturnal  grand  mal  seizures, 
recurring  once  every  two  or  three  weeks  and  later  more 
frequently.  They  were  not  preceded  by  any  aura,  but 
were  attended  by  loss  of  consciousness  and  contortions  of 
the  upper  and  lower  limbs,  and  with  post-convulsive 
tendencies   to   'walk   aroimd   and   talk  off.'      One   of   his 


SCHOOL  ORGANIZATION  357 

older  brothers  who  died  at  six  was  reported  to  be  'just 
like  him.' 

At  the  age  of  seven,  he  was  on  three  occasions  sent  to 
the  primary  room  of  the  schools,  staying  in  the  aggregate 
about  four  months,  but  was  dismissed  because  he  was  con- 
stantly 'playing  with  the  other  pupils  and  disturbing  the 
room.'  After  this,  he  was  given  private  instruction  at 
home  by  five  diiFerent  teachers,  but  only  in  the  literary 
branches.  His  worst  reported  fault  was  his  inability  to 
concentrate. 

In  the  clinic  examination,  he  was  found  to  have  the 
intelligence  of  a  child  of  6.2  years,  which  was  less  than 
his  chronological  age  when  he  entered  school  four  years 
earlier. 

He  was  unable  to  state  his  age,  to  carry  out  three  com- 
missions, to  repeat  a  sentence  of  sixteen  syllables,  to  read, 
to  descry  the  missing  parts  in  pictures^  to  write  from  a 
copy,  to  draw  a  diamond,  to  count  thirteen  pennies  or  to 
count  backward  from  twenty  to  zero.  He  said  that  he 
had  four  fingers  on  his  right  hand,  five  on  his  left  and  five 
on  both  hands,  that  three  two-cent  and  three  one-cent 
stamps  cost  six  cents,  he  called  yellow  green,  and  coimted 
thirteen  pennies  as  twelve.  But  he  was  able  to  give 
functional  definitions,  describe  pictures  and  name  the  four 
smallest  coins. 

Here  is  a  typical  case  of  epilepsy  superposed  upon  a 
substratum  of  imbecility.  Restoration  to  mental  normal- 
ity in  cases  of  this  sort  is  out  of  the  question  even  if  the 
epilepsy  were  curable  (which  it  is  not,  except  in  from  5  to 
10  per  cent  of  the  cases).  All  we  can  hope  to  do  for  this 
type  of  mental  abnormality  is  to  supply  discriminating 
hygienic,  dietetic  and  educational  treatment.  Whether 
educated  in  the  home,  school  or  institution,  these  children 
should  receive  the  kind  of  manu-mental  training  which  ^N-ill 


358    MENTAL  HEALTH  OF  SCHOOL  CHILD 

specially  prepare  them  for  the  type  of  industrial  service 
which  they  can  render  in  after  life.  These  individuals  will 
require  constant  surveillance  and  supervision  both  because 
of  their  seizures  and  because  of  their  mental  deficiency. 
Proper  care  can  usually  only  be  secured  in  the  state 
colonies.  Hygienic,  adaptable  occupations  in  the  open  air 
will  contribute  most  to  keep  them  healthy  and  happy. 
The  obligation  of  the  public  schools  is  to  afford  epileptics 
(as  well  as  other  types  of  mental  defectives)  differentiated 
treatment  in  segregated  classes  between  the  ages  of  six 
and  thirteen  or  fourteen,  and  then  at  the  beginning  of  the 
pubertal  period  graduate  them  into  the  state  colonies 
where  they  should  at  once  be  assigned  congenial  employ- 
ment. 

I  shall  now  present  a  few  defective  types  of  a  still 
higher  grade  of  mentality.  There  are  thousands  upon 
thousands  of  these  children  in  the  schools  of  the  nation, 
but  they  are  very  seldom  recognized  as  'defectives,'  partly 
because  their  physical  development  and  physical  exterior 
are  often  quite  normal,  partly  because  they  are  able  to 
apprehend  the  simpler  relations  of  life  fairly  well,  and 
frequently  can  talk  quite  fluently — a  child  who  has 
attained  a  mentality  of  seven  years  or  more  usually  has  a 
free  and  fluent  use  of  language — and  partly  because  they 
frequently  possess  a  degree  of  superficial  brightness  which 
deceives  all  except  the  experienced  expert  on  mental  defi- 
ciency. Some  of  the  children  of  this  type  examined  in  the 
clinic  who  were  indubitably  feeble-minded  have  been  pro- 
moted into  the  fourth  or  fifth  grades,  admitted  into 
ungraded  coaching-classes  and  elementary  industrial 
schools,  and  placed,  by  so-called  vocational  counselors,  in 
responsible  positions  which  they  were  never  able  to  hold, 
without  the  slightest  suspicion  on  the  part  of  the  teachers 


SCHOOL  ORGANIZATION  359 

or  vocational  directors  that  they  were  genuinely  defective. 
There  is  no  more  difficult  task  in  diagnosis  than  the 
diiferentiation  of  high-grade  morons  from  border-cases 
and  seriously  backward  children,  and  to  trust  anyone  to 
make  this  differentiation  but  an  experienced  psycho- 
clinical  expert  is  preposterous.  Surveys  or  estimates  made 
by  teachers,  principals  and  medical  inspectors  of  the  num- 
ber of  feeble-minded  children  in  the  schools  are  demon- 
strably worthless  and  misleading.  These  people  do  not 
recognize  a  high-grade  moron  or  border-line  defective 
when  they  see  one ;  to  have  amateurs  attempt  to  diagnose 
these  cases  by  formal  tests  is  pernicious. 

Case  6 

The  first  of  these  cases,  a  German- American  boy,  aged 
fourteen  years  seven  months  at  the  time  of  the  examination 
in  November,  1912,  presents  no  special  diagnostic  diffi- 
culties to  the  experienced  examiner. 

He  did  not  walk,  talk  or  cut  his  teeth  until  over  two 
years  of  age;  was  at  one  time  badly  burned  under  his 
right  arm  so  that  it  was  feared  that  he  would  perish; 
pertussis  at  two  and  measles  at  six;  'holds  his  mouth 
open  all  the  time  just  like  his  father  and  grandfather  did.' 

Lives  in  a  poor  section  but  in  a  clean,  well-ventilated 
and  comparatively  well-furnished  flat.  Plenty  of  food. 
The  mother,  apparently  of  low  mentality,  is  divorced  from 
the  child's  father,  a  drinker  who  would  not  support 
his  family.  Mother  says  the  great-grandmother  was 
peculiar. 

He  started  to  school  at  six  and  at  the  end  of  eight  years 
of  schooling  had  reached  only  the  second  grade.  He  was 
then  permitted  to  enter  an  elementary  industrial  school, 
where  he  remained  last  year  without  making  progress. 


360    MENTAL  HEALTH  OF  SCHOOL  CHILD 

He  did  not  return  to  school  this  year  and  his  present 
whereabouts  are  unknown  to  the  clinic.  The  school 
record  indicates  that  he  has  learned  to  write  fairly  well, 
to  spell  a  few  words,  and  to  add  and  subtract  simple 
combinations.  He  cannot  read  or  measure,  but  has  a 
fairly  good  memory,  and  'knows  all  the  slang  phrases  and 
uses  them  constantly.' 

The  boy  was  brought  to  me  by  one  of  the  students  in 
the  clinic  who  is  teaching  in  the  aforesaid  industrial  school 
and  who  suspected  that  all  was  not  right.  He  was  found 
to  suffer  from  three  carious  teeth  and  enlarged  tonsils, 
to  secure  treatment  for  which  he  was  referred  to  dispen- 
saries. In  physical  exterior,  he  appeared  absolutely  like 
a  normal  child.  Measurements,  indeed,  showed  that  he 
was  equal  to  the  boy  of  somewhat  over  fifteen  in  standing 
height,  of  seventeen  in  sitting  height,  of  sixteen  in  hand 
grip,  of  about  fourteen  and  a  half  in  weight  but  of  only 
thirteen  in  vital  capacity.  His  weight  is  too  light  for 
his  height,  and,  in  spite  of  his  limited  lung  capacity,  he 
is  quite  long-busted  or  brachyscelous  (ponderal  index 
equals  22,  normal  equals  23.1;  statural  index  equals  55.7, 
normal  equals  52). 

On  the  other  hand,  in  intellectual  development  this  boy 
has  grown  to  only  about  eight  and  one-half  years,  while 
in  motor  development  he  ranks  somewhat  over  ten  years, 
as  determined  by  the  form-board  test,  and  eight  years  and 
between  ten  and  eleven  years  for  the  right  and  left  hand, 
respectively,  as  determined  by  the  tapping  test. 

He  fails  on  both  of  the  Healy-Fernald  construction 
puzzles  (A  and  B)  after  trying  for  nearly  two  and  one- 
half  minutes.  His  memory  was  limited  to  less  than  five 
digits,  he  was  unable  to  count  backwards,  to  write  six 
syllables  from  dictation,  to  perform  the  weight  test,  to 
give  descriptive  definitions,  to  draw  the  two  designs  pre- 
sented for  ten  seconds  or  to  point  out  the  absurdities  in 


SCHOOL  ORGANIZATION  361 

silly  statements.  He  required  twenty-one  seconds  to  read 
ten  words  with  aid  in  the  reading  selection,  and  was  able 
to  reproduce  three  memories.  He  could  name  only  thirty- 
six  words  in  three  minutes,  said  that  three  two-  and  three 
one-cent  stamps  cost  ten  cents,  gave  the  date  of  November 
22  as  December  21,  constructed  three  separate  sentences 
instead  of  a  single  sentence  with  the  three  designated 
words,  gave  the  months  of  the  year  as  August,  September, 
December  and  February  and  gave  as  rhymes  of  'spring' 
the  words  'ring,'  'king'  and  'rang.' 

It  is  almost  inconceivable  that  this  boy,  a  middle-grade 
moron  of  the  simple  type,  should  be  retained  as  a  backward 
boy  for  eight  years  in  the  first  two  grades  with  the  hope 
of  restoring  him  to  normality,  then  to  be  transferred  to 
an  elementary  industrial  school  for  'motor-minded'  boys 
(what  a  beautiful  phrase  to  conjure  with  and  behind 
which  to  conceal  the  profoundest  ignorance),  and  finally 
to  come  before  a  bureau  for  vocational  guidance.  No 
matter  how  apparently  impossible  and  inconceivable,  such 
are  the  facts.  Could  there  be  a  more  tragic  indictment  of 
the  unscientific  manner  in  wliich  the  majority  of  public 
schools  and  vocational  guidance  bureaus  are  now  admin- 
istered.'' Is  it  not  evident  that  there  can  be  no  talk  of 
vocational  guidance  so  long  as  not  the  slightest  attempt 
is  made  to  evaluate  scientifically  the  mental,  physical  and 
vocational  status  of  many  of  the  applicants.^  Vocational 
guidance  without  psychological,  vocational  and  physical 
diagnosis  for  at  least  all  abnormal  cases  is  not  merely 
dilettantish  and  absurd,  it  is  impossible.  Let  us  call  this 
sort  of  work  by  its  true  name,  vocational  placement  and 
not  vocational  guidance.  Most  of  the  modem  school  voca- 
tional guidance  bureaus  are  largely  misnomers :  they  are 
merely  vocational  survey  and  employment  bureaus.     But 


362    MENTAL  HEALTH  OF  SCHOOL  CHILD 

the  schools  of  the  country  are  going  to  provide  genuine 
vocational  guidance  based  upon  a  bedrock  of  scientific 
diagnosis  of  the  individual  applicant,  just  as  soon  as 
society  comes  to  realize  that  the  future  health  and  pros- 
perity of  the  children  leaving  the  schools  for  work 
depend  fundamentally  upon  their  placement  in  positions 
whose  exactions  are  compatible  with  their  general  level  of 
mental  functioning  and  not  incompatible  with  their  indi- 
vidual physical  weaknesses.  To  place  children  in  positions 
which  they  cannot  possibly  fill  is  mischievous  and 
reprehensible. 

Let  me  reinforce  these  conclusions  by  the  two  following 
cases. 

Case  7 

A  boy,  aged  sixteen  at  the  time  of  the  examination  in 
April,  1912. 

His  record  shows  that  he  was  the  youngest  of  four 
children;  he  learned  to  talk  at  least  one  and  one-half 
years  late ;  pertussis  and  measles  at  three ;  diphtheria  at 
five,  which  seemed  to  impair  his  power  of  retentiveness ; 
he  showed  a  tendency  to  play  by  himself. 

He  entered  school  at  six,  reaching  the  fourth  grade 
after  eight  years ;  always  had  difficulty,  making  no  prog- 
ress in  number  work,  especially  in  subtraction,  and  never 
learned  to  read.  A  good  boy,  but  played  truant  because 
he  did  not  like  school,  especially  did  not  like  to  be  in  a 
class  of  smaller  children,  and  dropped  out  entirely  some 
time  after  being  examined  in  the  clinic. 

In  the  examination  the  eyes  and  tonsils  were  found 
defective,  and  he  was  referred  to  a  dispensary,  where 
glasses  were  supplied.  Superficially  he  appeared  to  be 
perfectly  normal  in  physical  development.     As  a  matter 


SCHOOL  ORGANIZATION  363 

of  fact,  in  standing  height  and  weight,  he  was  only  a 
trifle  short,  measuring  15.5  in  the  former  and  nearly  the 
same  in  the  latter,  while  in  sitting  stature  he  measured 
less  than  15,  in  head  circumference  13,  but  in  vital 
capacity  only  12.5.  In  strength  of  grip  he  was  about 
normal  for  his  age,  although  relatively  stronger  with  the 
left  than  right  hand.  He  was  slightly  too  light  for  his 
height  and  age  and  his  bust  was  rather  too  short  (ponderal 
index  equals  22.7,  normal  equals  23.4 ;  statural  index 
equals  50.7,  normal  equals  51). 

But  his  significant  deficiency  was  mental  not  physical. 
In  intelligence  he  measured  only  nine  years  and  in  motor 
development  only  seven  and  one-half. 

He  succeeded  with  the  simpler  of  the  Healy-Fernald 
construction  puzzles  (A)  after  131  seconds,  but  failed  on 
the  more  difficult  one  (B)  after  three  and  one-half 
minutes.  He  was  able  to  add  five  and  six,  and  seven  and 
eight  correctly,  but  unable  to  subtract  seven  from  thirty- 
one,  or  sixteen  from  twenty-eight;  twenty-five  cents  minus 
six  cents  in  the  change  test  gave  twenty-four  cents.  He 
could  not  define  descriptively,  or  correctly  distinguish  the 
five  weights,  or  give  three  monosyllabic  rhymes,  or  repeat 
six  digits,  or  perceive  absurdities.  He  named  the  months 
as  April,  July,  May  and  June,  but  was  able  to  recognize 
all  the  coins. 

This  boy  was  recommended  to  a  special  class  as  a  case 
of  high-grade  defectiveness  (of  higher  caliber  than  indi- 
cated by  the  Binet  tests),  complicated  with  alexia.  Think 
of  the  years  of  wasted  effort  spent  in  trying  to  teach 
a  word-blind,  feeble-minded  boy  to  read  by  ordinary 
methods ! 

On  December  19,  1913,  or  nearly  a  year  and  eight 
months  after  the  initial  examination^  the  boy  came  to  the 
clinic  for  the  tliird  time.     By  the  Binet  system,  he  now 


364    MENTAL  HEALTH  OF  SCHOOL  CHILD 

ranked  10.2  years;  that  is^  he  had  gained  1.2  years;  but 
this  considerable  gain  is  partly  due  to  the  fact  that  he 
passed  the  ten-year  standard,  on  which  he  had  failed  the 
first  time.  He  still  failed  on  four  of  the  six  nine-year 
tests.  He  now  did  the  change  test  and  selected  the 
weights  in  the  order  of  heaviness  but  failed  to  repeat  the 
days  in  order  (Monday,  Tuesday,  Wednesday,  Friday, 
Saturday).  He  gave  the  months  as  April,  May,  June, 
July,  September,  November.  He  was  able  to  give  the 
date  and  year  correctly  but  not  the  month.  He  gave  only 
forty  words  in  three  minutes  but  solved  the  absurdities 
(eleven),  resistance-to-suggestion  (twelve)  and  drawing- 
of-diamond  (thirteen)  problems.  He  did  the  more  diffi- 
cult of  the  Healy-Fernald  construction  puzzles  (B)  in 
fifty-eight  seconds,  which  he  failed  to  solve  the  first  time, 
and  opened  the  Healy-Fernald  instruction  box  without 
hesitation.  He  did  the  Vineland  form-board  in  3.2 
seconds  less  time  than  at  first,  thus  measuring  a  little 
higher  than  nine  years,  or  1.5  years  higher  than  the  first 
time.  He  did  not  know  all  the  letters  of  the  alphabet, 
reading  f  as  k,  q  as  o,  g  as  d,  z  as  i,  y  as  u  and  j  as  1.  He 
read  'to'  and  'the'  correctly  but  'it'  as  'in'  and  'in'  as  'is.' 
He  was  able  to  reproduce  ten  memories  from  the  experi- 
menter's reading  of  the  selection  as  against  five  the  first 
time.  On  the  physical  side  he  had  gained  very  consider- 
ably: two  and  one-half  years  in  standing  height  and  lung 
capacity,  making  him  more  than  equal  to  the  eighteen- 
year-old  in  the  former  and  equal  to  the  fifteen-year-old 
in  the  latter;  he  had  gained  over  a  year  in  sitting  height 
and  weight,  reaching  a  sixteen-year  development;  and  in 
strength  of  grip  he  had  also  advanced  somewhat.  He 
has  thus  become  increasingly  light  for  his  height  and  also 
increasingly  short-chested. 

It  is  evident  that  the  boy  has  grown   an  appreciable 
extent  both  mentally  and  physically  during  the  lapse  of 


SCHOOL  ORGANIZATION  365 

the  year  and  eight  months.  Shall  we  say  that  this  mental 
growth  is  due  to  the  fact  that  he  has  been  out  of  school  at 
work?  There  is,  to  me,  not  the  slightest  doubt  that  a  boy 
of  this  type  will  improve  more  mentally  if  kept  busy  at 
out-of-school  tasks  which  he  can  do,  than  if  confined  in  the 
regular  classroom  and  compelled  to  labor  over  work  for 
which  he  has  no  aptitude  and  which  he  can  never  compre- 
hend. There  is  no  doubt  that  our  unscientific  systems  of 
school  classification,  rigid  methods  and  hyper-uniformity 
of  curricular  requirements  have  immeasurably  retarded  the 
mental  development  of  innumerable  exceptional  children. 
However,  the  laboratory  study  and  vocational  record 
of  this  boy  confirmed  the  earlier  diagnosis  of  high-grade 
feeble-mindedness.  During  a  period  of  less  than  one  and 
one-half  years,  he  has  held  at  least  six  different  jobs, 
retaining  each  only  from  one  to  three  months,  and  receiv- 
ing in  weekly  pay  from  $5  to  $9.  One  of  these  positions 
was  given  him  by  his  cousin,  while  his  latest  position  was 
secured  through  the  friendship  of  the  employer  for  his 
grandfather.  But  liis  present  employer  reports  that  he 
cannot  use  him  after  January  1,  1914,  because  the  boy 
possesses  'no  independence.'  He  has  to  be  'told  over  and 
over  again  how  to  do  a  thing  and  then  cannot  do  it,'  he 
has  'a  poor  memory  and  can  only  do  mechanical  things.' 
So  the  boy  will  soon  have  to  resume  his  perennial  job- 
hunting.  This  is  indeed  the  sad  but  universal  story  of 
morons,  border-line  cases  and  the  very  seriously  backward 
children.  Is  it  not  worth  while  for  vocational  guidance 
bureaus  to  make  a  scientific  appraisal  of  the  mental  level 
of  vocational  applicants.''  Is  it  not  worth  while  for  the 
public  schools  to  select  these  cases  early  in  their  school 
career  for  special  treatment  and  then  transfer  them  to 
colonies  where  they  may  work  contentedly  and  effectively 


366    MENTAL  HEALTH  OF  SCHOOL  CHILD 

under  supervision? — for  without  kind  and  eiRcient  super- 
vision these  children  nearly  always  fail.  At  large  in 
society  under  modern  competitive  conditions,  they  are 
almost  invariably  doomed  to  utter  industrial,  and  fre- 
quently moral,  shipwreck.  Is  it  not  an  imperative  obliga- 
tion on  the  part  of  society  to  save  the  large  army  of 
high-grade  defectives  from  unavoidable  pauperism,  from 
enforced  criminal  careers  and  from  the  reproduction  of 
their  kind,  by  forcibly  placing  them  in  self-sustaining 
colonies  .f^  These  are  fundamental  social  questions  which 
the  state  and  the  state-supported  schools  cannot  shirk. 
There  are  no  more  important  questions  in  our  entire  social 
economy.  The  public  schools  are  the  great  clearing- 
house, the  common  Ellis  Island,  through  which  all  children 
must  pass.  The  burden  of  selection  and  classification  thus 
rests  primarily  upon  the  schools. 

Case  8 

My  next  case  is  a  so-called  defective  delinquent  who  was 
brought  to  the  clinic  by  a  probation  officer  of  the  juvenile 
court,  an  Italian  boy  born  in  America,  aged  fourteen  years 
eleven  months  at  the  time  of  the  examination  in  May,  1912. 

He  was  the  seventh  of  eight  children,  four  of  whom 
died  during  the  first  year  of  life;  birth  and  development 
normal,  never  ill,  bright  as  an  infant.  One  child  died  in 
spasms  and  the  youngest  suffered  from  weak  ankles  and 
convulsions.  The  mother  has  developed  an  abdominal 
tumor. 

'Learned  very  little  in  school/  was  never  able  to  read 
much  but  was  promoted  to  the  fourth  grade.  He  was 
brought  by  the  mother  before  the  juvenile  court  in  May, 
1906,  because  of  persistent  incorrigibility  and  truancy; 
attended   school   about   two   days    a   week.      Released   on 


SCHOOL  ORGANIZATION  367 

probation^  but  was  returned  after  a  few  months  because 
of  truancy  and  vagabondage.  Lived  in  the  streets  and 
rarely  came  home  for  meals,  but  subsisted  on  cakes  and 
pies  from  the  restaurants.  Was  committed  to  a  boys'  indus- 
trial home  but  was  again  released  on  probation.  On 
failure  to  improve,  he  was  placed  in  the  court's  detention 
home  in  June,  1909,  for  one  week  and  was  then  sent  home 
because  he  'seemed  so  small.'  A  process  issued  for  him 
in  May,  1910,  because  he  had  played  truant  and  loafed 
around  the  Pennsylvania  station,  was  not  served  as  the 
school  principal  reported  that  he  was  doing  better.  In 
October,  1910,  he  was  committed  to  a  private  home  away 
from  the  city.  Here  he  'improved  wonderfully  physically,' 
worked  steadily  and  his  conduct  was  good,  except  that  he 
ran  away.  Was  released  from  the  home  in  March,  1912, 
on  the  mother's  petition,  because  she  was  contributing 
slightly  towards  his  support  and  instead  wanted  the  boy 
to  help  support  her. 

In  May,  1912,  he  was  brought  to  my  clinic  for  exami- 
nation and  was  found  to  suffer  from  bad  oral  conditions 
(he  was  referred  to  the  Dental  College  of  the  University 
where  he  had  ten  or  twelve  fillings  made  gratuitously). 
In  physical  development  he  was  very  much  stunted, 
measuring  in  stature  about  10.5  years,  in  weight  between 
10.5  and  11,  in  sitting  stature  nearly  11.5,  in  vital  capac- 
ity nearly  12  and  in  dynamometry  12.5  with  the  right 
and  12  with  the  left  hand.  His  weight  was  about  normal 
for  his  height  but  he  was  of  the  long-busted  type  of 
stature  (ponderal  index  equals  23.4,  normal  equals  23.1; 
statural  index  equals  54.4,  normal  equals  52). 

His  intellectual  development  was  about  on  a  par  with 

his  physical  growth,  somewhat  less  than  10.5  years.     In 

motor  development,  he  graded  a  little  better,  or  11  years. 

He  did  both  of  the  Healy-Fernald  construction  puzzles 

(A  in  fifteen  seconds  and  B  in  fifty-three  seconds),  and 


368    MENTAL  HEALTH  OF  SCHOOL  CHILD 

opened  the  combination  safe  in  twenty-five  seconds.  He 
gave  sixty  words  in  three  minutes  but  failed  on  the  design 
and  suggestion  tests  in  ages  ten  and  twelve.  A  short  time 
after  the  clinic  examination,  he  was  placed  in  a  private 
special  class. 

On  December  9,  1913,  a  social  investigator  of  the  clinic 
found  the  mother  in  despair  over  the  boy,  who  now,  at  the 
age  of  16.5  years,  was  constantly  changing  his  jobs, 
staying  out  late  at  night,  getting  up  between  twelve  and 
one  o'clock  in  the  daytime,  spending  part  of  his  time 
loafing  around  the  station,  where  he  was  the  easy  tool  and 
cat's-paw  of  hoodlums.  He  was  defiant  of  his  mother, 
who  now  had  no  control  over  him.  She  says  'bad  boys 
make  John  bad  and  call  him  scab  when  he  work.'  Still  'I 
no  want  him  go  school.     He  can  earn  money,  I  sick.' 

On  the  following  day  the  boy  was  reexamined  in  the 
clinic.  He  seemed  to  be  very  glad  to  meet  the  examiner, 
was  very  responsive  and  appeared  bright  and  intelligent. 
He  reported  that  he  had  been  out  of  the  control  of  the 
juvenile  court  for  nine  months,  that  he  attended  an  ele- 
mentary industrial  school  for  a  while  but  did  not  like  the 
work  because  the  reading,  electrical  and  wood  work  were 
too  hard,  and  because  he  was  punished  when  he  made  a 
mistake.  (Here  is  an  unrecognized  high-grade  defective 
in  an  elementary  industrial  school  who  is  punished  because 
he  does  not  do  the  required  work,  when  the  real  fact  is 
that  he  is  feeble-minded  and  cannot  possibly  do  the  work. 
This  reads  like  a  chapter  from  the  medieval  inquisition.) 
He  held  a  job  for  a  couple  of  months  painting  vehicles  at 
$6.60  per  week,  but  quit  because  he  cut  his  finger,  he 
delivered  flowers  for  a  while  at  $4.50  per  week,  he  carried 
messages  at  two  cents  each,  yielding  from  $4.00  to  $4.50 
per  week,  for  the  Western  Union  three  weeks  ago  for  two 
months  (note  the  discrepancy),  but  quit  because  he  had 
to  run  too  much;  he  now  sells  peanuts  in  a  theater  after- 


SCHOOL  ORGANIZATION  369 

noons  and  evenings,  clearing  about  $2.70  per  week.     He 
said  the  street  loafers  hit  him  and  called  him  scab. 

The  psychological  examination  showed  that  the  boy  did 
a  little  better  in  some  things  than  he  did  when  examined  a 
year  and  seven  months  earlier,  but  that  in  general  intelli- 
gence he  had  gained  only  about  .2  of  a  year.  In  motor 
development,  he  showed  a  slightly  greater  increase  but 
was  still  far  below  normal.  In  physical  development,  he 
had  improved  far  more,  having  grown  about  2.5  years  in 
standing  and  sitting  stature  and  weight,  and  about  1.5 
years  in  lung  capacity  and  hand  squeeze.  But  even  thus, 
he  ranked  in  bodily  development  only  as  a  child  from 
thirteen  to  fifteen. 

Here  is  a  so-called  defective  delinquent  who  was  not 
recognized  as  a  defective  either  in  the  schools  or  the 
juvenile  court.  As  a  matter  of  fact,  this  boy  is  primarily 
a  defective  and  only  secondarily  a  delinquent.  He  has 
never  committed  any  serious  crime,  so  far  as  I  know. 
Inherently  he  is  not  vicious.  But  his  mental  deficiency 
makes  him  an  easy  dupe  for  evil  boys  and  makes  it  almost 
impossible  for  him  to  retain  a  paying  position.  If  left 
at  large  he  will  almost  surely  drift  into  pauperism  and 
crime,  and  society  will  have  to  pay  the  penalty.  Would  it 
not  be  more  rational  and  economical  to  classify  children 
of  this  type  early  in  their  school  careers,  supply  them  with 
proper  manu-mental  training,  and  then  graduate  them  into 
the  state  colonies  where  they  should  be  compelled  to  live 
their  lives  in  innocent,  happy  and  useful  service.'' 

Case  9. 

Somewhat  different  is  the  following  morally  unstable 
retardate,  an  embryonic  delinquent  who  comes  from  a 
morally  and  socially  defective  home,  a  boy  bom  in  Naples, 


370    MENTAL  HEALTH  OF  SCHOOL  CHILD 

aged    twelve    years    eleven    months    at    the    time    of    the 
examination  in  October,  1913. 

He  was  the  second  of  six  children^  born  at  full  term, 
weighed  eight  pounds,  nursed  for  fifteen  months,  walked 
and  talked  at  1.5  years;  about  this  time  experienced  a 
'stoppage  in  speech' ;  at  five,  fell  and  broke  his  nose,  which 
since  then  has  been  bleeding  almost  daily  so  that  in  the 
morning  his  pillow  is  usually  blood-stained.  Measles, 
whooping  cough,  mumps  and  scarlet  fever  at  seven,  since 
which  time  he  has  acted  'queer.'  He  is  gluttonous,  drinks 
tea,  coiFee  and  beer  and  chews  tobacco.  Quick-tempered, 
untruthful,  disobedient,  cruel  to  brothers  and  sisters,  lies 
and  steals.  When  sent  to  the  store  to  make  purchases,  he 
will  appropriate  the  money  for  his  own  use  and  have  the 
goods  charged  to  his  parents.  He  has  also  appropriated 
money  which  he  has  collected  for  his  church,  which  he 
never  attends,  although  he  is  sent  there.  When  punished 
at  home,  he  'screams  and  yells  terribly,'  runs  away  and 
stays  out  all  night.  He  has  slept  in  a  dog  box  and  on  the 
hillside,  and  he  is  never  at  home  except  for  meals  and  to 
sleep ;  he  usually  loafs  in  the  woods  with  a  gang  of  older 
boys. 

The  home  conditions  are  fairly  good  financially, 
although  the  mother  makes  repeated  trips  to  the  Asso- 
ciated Charities  whenever  a  child  is  to  be  born.  She  is 
probably  immoral,  wishes  to  get  rid  of  her  children,  is  very 
lazy,  fails  to  prepare  the  meals  properly  and  leaves  her 
new  house  of  five  rooms  in  a  filthy,  unventilated,  dis- 
ordered condition.  The  house  contains  nine  lodgers, 
exclusive  of  two  dogs,  three  cats  and  a  goat.  The  cats 
have  been  seen  to  walk  on  the  table  at  meal-time  and  help 
themselves  from  the  dishes.  The  whole  family  will  sleep 
in  the  same  bed,  although  other  beds  have  been  given  to 
them  by  the  Associated  Charities.  The  home  life  is  tem- 
jDcstuous  and  degrading.     The  child  is  poorly  disciplined. 


SCHOOL  ORGANIZATION  371 

whipped^  abused  and  called  'crazy'  by  the  father.  The 
father  also  abuses  his  wife.  The  parents  are  intemperate, 
but  the  family  history  is  negative,  except  that  the  mother's 
father  was  rheumatic. 

The  boy  has  been  in  school  fifty-three  months  and  has 
reached  the  fourth  grade.  He  has  spent  two  years  each 
in  the  first  and  second  grades.  His  poorest  work  is  in 
reading  (he  reads  in  fourth  reader),  memorizing  and 
spelling,  and  his  best  work  is  in  music,  manual  training, 
drawing  and  abstract  work.  He  cannot  do  the  fundamental 
arithmetical  processes.  He  has  good  powers  of  observa- 
tion and  concentration.  Some  teachers  say  that  he  is  one 
of  the  best-behaved  and  others  that  he  is  the  worst- 
behaved  pupil  in  the  school.  He  apparently  has  a  dual 
nature :  at  times  interested,  willing,  obedient  and  cheerful ; 
at  other  times  cranky,  obstinate,  sullen,  devilish  and 
resentful  of  reproof,  threatening  to  kill  someone  when 
angry.  Also  has  a  'dual  walk,'  at  times  he  stamps  his 
feet,  at  other  times  he  walks  normally  (but  his  gait  is 
poor).  After  his  mother  had  reported  his  incorrigibility 
to  the  school  authorities,  he  changed  for  the  worst  and 
tried  to  live  up  to  his  reputation ;  but  punishment  in  school 
resulted  in  improvement.  His  teacher  says  he  has  been 
well-behaved  for  the  past  nine  months. 

The  clinic  examination  showed  that  the  child  was 
suffering  from  a  slight  degree  of  astigmatic  myopia,  two 
dental  caries,  enlarged  tonsils,  enlarged  adenoid  growth, 
enlarged  left  turbinate  and  deviating  septum  (he  was 
referred  to  a  dispensary  for  treatment  but  nothing  has 
been  done  because  of  parental  objections).  He  was 
retarded  in  both  physical  and  mental  development,  in  hand 
grip  measuring  about  12  years,  in  vital  capacity  11,  in 
weight  10.5,  in  standing  and  sitting  stature  a  little  over 
9.5,  and  in  head  girth  6.  His  ponderal  index  was  a  little 
better   than   normal    (23.8   vs.    23.1),   while   his   statural 


372    MENTAL  HEALTH  OF  SCHOOL  CHILD 

proportions  indicate  that  he  is  a  little  brachyscelous  (53.8 
vs.  53). 

In  motor  development,  he  grades  between  nine  and  ten 
and  in  intelligence  ten  (although  he  passed  two  of  the 
thirteen-year  tests). 

He  passed  all  of  the  tests  in  age  nine,  two  in  ten 
(months  and  money),  one  in  twelve  (three  rhymes)  and 
two  in  thirteen  (diamond  and  reversed  triangle  tests). 

Here  is  a  boy  who  is  just  as  genuinely  deficient  as  a 
feeble-minded  boy  but  to  a  lesser  extent.  The  difference 
is  one  of  degree.  His  is  a  case  of  pronounced  instability  of 
disposition  superposed  on  a  background  of  pronounced 
backwardness,  aided  and  abetted  by  a  demoralizing  home 
environment.  The  orthogenic  treatment  indicated  here 
is  not  merely  surgical  attention  and  corrective  pedagogic 
treatment  in  a  special  class,  preferably  in  a  parental 
school,  but  the  reconstruction  of  the  social  and  moral  con- 
ditions in  the  home.  Eventually  the  schools  will  have  their 
educational  laboratories  and  clinics  with  a  staff  of  social 
workers  who  will  study  the  social  influences  of  the  home  and 
street  which  predestinate  many  children  to  deficiency  or 
delinquency.  And  eventually  the  state  will  take  steps  to 
forcibly  reconstruct  the  home  whenever  it  tends  to  debauch 
childhood,  or  the  children  will  be  removed  from  the  homes 
and  placed  in  institutions. 

I  turn  now  to  three  types  of  supemorTnal  children.  The 
need  of  scientifically  classifying  supernormal  pupils  is 
even  more  urgent  and  the  value  to  be  derived  from  their 
efficient  pedagogical  training  is  even  greater  than  the 
classification  and  special  treatment  of  subnormal  children. 

Case  10 
An   American   girl   of   English-Scotch   ancestry,    aged 


SCHOOL  ORGANIZATION  373 

eight  years  four  months  at  the  time  of  the  examination  in 
August,  1912. 

An  only  child  who  developed  normally  save  for  delayed 
dentition  (teething  began  at  two).  Typhoid-pneumonia 
at  three  and  one-half,  attended  by  loss  of  consciousness, 
and  by  severe  intermittent  convulsions  for  three  days. 
Convulsions  recurred  once  six  months  later.  Measles  at 
four.  For  five  years  affected  by  convulsive  tics  of  the 
shoulders  and  arms,  which,  however,  had  shown  improve- 
ment five  weeks  prior  to  examination.  Sleep  restless  and 
disturbed  by  dreams ;  loses  temper  constantly ;  takes  cold 
easily. 

The  home  conditions  are  good.  Father  decidedly  rest- 
less from  childhood;  subject  to  impulsive  tics,  picks  up 
objects  repeatedly,  is  intense  in  action.  Mother's  father 
is  alive  at  seventy-eight,  but  subject  to  convulsions  about 
once  a  week,  said  to  be  brought  on  by  excitement. 
Mother's  mother  died  at  seventy  of  nervous  prostration, 
father's  father  accidentally  killed  at  forty-seven;  father's 
mother  died  at  fifty-nine  of  chronic  inflammation  of  the 
bowels. 

This  girl  had  been  in  school  twenty-three  months  and 
was  seven  months  advanced  in  her  work  (IV  B  instead  of 
III  B)  ;  is  good  in  all  branches,  especially  in  reading, 
spelling  and  telling  stories.  Worst  faults,  restlessness 
and  quick  temper. 

At  the  time  of  the  clinic  examination,  she  was  subject 
to  tics  of  the  arms  and  nervous  starts  affecting  the  whole 
body.  The  roots  of  eight  deciduous  teeth  were  in  very 
bad  condition  (she  was  referred  to  the  Dental  College  for 
expert  examination  and  treatment).  In  physical  develop- 
ment she  was  about  normal,  rating  about  9  in  hand  grip 
for  the  right  hand  and  8  for  the  left  hand,  9  in  standing 
stature,  8.5  in  sitting  stature  and  vital  capacity,  and  about 
8  in  weight.     But  she  is  too  light  for  her  weight  and  is 


374    MENTAL  HEALTH  OF  SCHOOL  CHILD 

somewhat  short-chested  (ponderal  index  equals  22.4 
instead  of  23.8;  statural  index  equals  54  instead  of  55). 
In  intelligence  she  grades  twelve  years,  or  3.5  acceler- 
ated, passing  all  the  tests  in  age  ten  and  all  except  one 
each  in  ages  nine  (making  change),  eleven  (absurdities) 
and  twelve  (problems). 

This  is  a  beautiful  illustration  of  distinct  youthful  pre- 
cocity resting  upon  a  pathological  background.  Judging 
from  the  standpoint  of  intellectual  maturity,  this  girl  was 
marking  time  in  the  schools.  She  should  have  been 
advanced  at  least  two  years  instead  of  seven  months. 
However,  this  girl  cannot  be  classified  purely  according  to 
her  degree  of  intelHgence.  She  distinctly  belongs  to  the 
neuropatliic  type  of  supemormals,  and  requires  a  most 
discriminating  educational  and  hygienic  regimen.  Unless 
this  fact  is  recognized  and  appropriate  treatment  is 
accorded  her  in  the  schools,  the  schools  certainly  will  be 
guilty  of  contributory  negligence  in  furthering  the 
development  of  possible  adult  instabilities  in  this  child. 
Many  adult  neuropaths  and  psychopaths  have  been  manu- 
factured by  the  unscientific  and  indiscriminating  treatment 
which  mentally  abnormal  children  have  received  in  the 
home  and  school. 

Case  11 

My  next  case  is  also  a  nervously,  although  non-patho- 
logically,  precocious  child,  an  American  girl,  aged  nine 
years  four  months  at  the  time  of  the  examination  in 
March,  1913. 

She  is  the  oldest  of  three  children,  with  a  record  of 
normal  birth  and  normal  development;  scarlet  fever  at 
four  years  and  three  months,  pertussis  and  measles  at  six ; 
is  nervous,  sleepless,  easily  fatigued,  suffers  from  frontal 


SCHOOL  ORGANIZATION  375 

headache,  subject  to  fears,  afraid  to  go  to  her  room  in  the 
dark.  Operated  at  six  for  adenoids  and  enlarged  tonsils. 
One  feeble-minded  aunt  and  an  epileptic  relative. 

She  was  advanced  in  her  school  work,  being  in  the 
fourth  grade  after  twenty-seven  months  of  schooling.  She 
was  good  in  all  branches,  but  best  in  reading,  drawing  and 
music. 

In  the  clinic  she  was  nervous  and  fidgety.  Her  tonsils 
were  found  to  be  considerably  enlarged  and  infected.  In 
physical  growth,  she  was  distinctly  superior  to  the 
average,  measuring  fully  12  years  in  strength  of  grip 
and  sitting  height,  11.5  in  weight,  11  in  standing  height 
and  10  years  in  vital  capacity.  She  is  long-busted,  but  her 
weight  is  about  normal  for  her  height  (ponderal  index 
equals  23.6,  normal  equals  23.5 ;  statural  index  equals 
55.9,  normal  equals  55). 

In  intelligence,  she  graded  11.8  years  but  in  motor 
development  only  10  years.  In  the  tapping  test  she 
graded  a  little  less,  but  she  solved  (in  two  minutes)  the 
construction  puzzle  (B)  which  requires  intelligent  adap- 
tation. She  passed  all  the  tests  in  ages  nine  and  ten,  all 
except  the  association  test  in  eleven,  two  tests  in  twelve 
(rhymes  and  memory  for  sentences),  and  the  diamond 
test  in  thirteen. 

Intellectually  this  girl  had  the  capacity  to  do  work  one 
or  two  years  in  advance  of  her  school  classification,  and 
there  is  no  reason  why  she  should  not  be  permitted  to  work 
at  an  accelerated  pace,  provided  she  is  kept  in  good 
physical  condition  and  provided  the  pressure  is  relaxed 
somewhat  during  her  periods  of  accelerated  physical 
growth. 

On  the  advice  of  the  clinic,  the  father,  a  school  princi- 
pal, immediately  had  her  tonsils  dissected,  and  during  the 
months  of  July  and  August  he  kept  her  on  a  farm  in  the 


376    MENTAL  HEALTH  OF  SCHOOL  CHILD 

country  where  she  received  plenty  of  wholesome  food,  fresh 
air  and  out-of-door  exercise.  As  a  result,  the  girl  returned 
at  the  beginning  of  the  present  school  year  in  excellent 
condition  physically  and  mentally.  The  nervous  symptoms 
had  disappeared  and  she  now  ranks  first  in  her  class.  It 
is  uneconomical  of  public  funds  and  wasteful  of  human 
brain  power  to  keep  children  eight  years  in  the  grades  who 
can  finish  the  course  just  as  well  in  six  years. 

Case  12 

This  conclusion  will  be  further  enforced  by  the  con- 
sideration of  my  final  case,  a  healthy  type  of  supernormal 
child,  a  girl  aged  five  years  seven  months  at  the  time  of 
the  examination  in  August,  1912. 

She  was  the  second  of  three  children,  weighing  ten 
pounds  at  birth,  walked  in  the  fourteenth  month,  used 
words  in  the  twelfth  and  sentences  in  the  sixteenth  and 
had  ten  teeth  in  the  tenth  month.  Chicken  pox  and  severe 
stomach  trouble  in  her  third  year. 

Mother's  mother  got  overheated  and  died  of  inflamma- 
tion of  the  brain  at  forty-four  (during  climacteric),  a 
paternal  aunt  suffered  from  tuberculosis,  and  neuras- 
thenia, developing  into  a  type  of  insane  dementia,  from 
which  she  died  at  thirty-six. 

Home  conditions  excellent;  she  is  good  in  handwork, 
can  clear  table,  iron  plain  clothes  and  do  construction 
work  with  building  blocks. 

At  the  clinic,  her  muscular  coordination  was  good,  her 
eyes  were  good  in  respect  to  binocular  coordination  and 
distance  and  light  accommodation,  but  her  nasopharynx 
was  slightly  congested  and  she  was  somewhat  flat-footed. 

In  physical  growth,  she  was  distinctly  superior  to  the 
average,  equaling  9.5  years  in  dynamometry,  7  years  in 
standing  height  and  weight  and  6.5  in  sitting  height. 


SCHOOL  ORGANIZATION  377 

Her  physical  superiority  was  paralleled  by  her  mental 
superiority.  In  intelligence  and  motor  development,  she 
graded  about  7.5  years. 

She  passed  all  the  tests  in  age  six,  five  in  seven  (she 
could  not  write  from  copy,  describe  pictures  or  recognize 
a  twenty-five  cent  piece),  three  in  eight  (passing  the 
stamp,  color  and  statement-of-difFerence  tests),  one  in 
nine  (repetition  of  week  days)  and  none  in  ten.  She 
failed  on  the  construction  puzzle  (B)  after  seventy-five 
seconds. 

There  are  hundreds  of  healthy,  gifted  children  such  as 
this  girl  in  every  community  of  any  size  who  would  be 
able  to  finish  the  eight  elementary  grades  in  six  years  or 
less  if  they  were  only  afforded  the  opportunities  by  the 
schools,  and  they  would  do  so  with  distinction  and  without 
in  the  least  imperilling  either  their  physical  or  mental  well- 
being,  provided,  of  course,  due  checks  were  kept  on  their 
temporary  health  deviations  and  growth  accelerations. 

The  conservation  of  the  mental  health  of  school  children 
demands  not  only  that  we  shall  select,  classify  and  provide 
specialized  training  for  cliildren  of  inferior  ability,  but 
(even  more  insistently)  that  we  differentiate  children  of 
superior  attainments  and  organize  for  their  benefit  systems 
of  flexible  grading,  special  supernormal  or  special  oppor- 
tunity classes,  and  differentiated  pedagogic  treatment. 
Surely  the  conservation  and  promotion  of  the  mental 
health  of  gifted  children,  who  are  destined  to  become  the 
leaders  of  social  progress,  is  even  more  important  than 
providing  special  opportunities  for  defectives.  One 
inventive  genius  is  worth  more  to  society  than  a  hundred 
drones.  It  is  the  mission  of  the  schools  to  foster  and  not 
to  suppress  genius.  The  school  systems  of  the  past,  with 
their  emphasis  on  uniformity,  on  the  essential  likeness  of 


378    MENTAL  HEALTH  OF  SCHOOL  CHILD 

children,  on  equivalence  of  pedagogical  treatment  and  on 
mass  results,  have  tended  to  develop  sameness,  subservience 
and  mediocrity.  The  school  systems  of  the  future,  with 
their  emphasis  on  diversity,  on  the  essential  difference  of 
children,  on  differentiated  pedagogical  treatment  and  on 
individual  results,  will  foster  individuality,  independence 
and  genius.  The  ideal  of  the  past  was :  a  uniform  pro- 
gram of  work  and  a  uniform  rate  of  progress  for  all  the 
pupils.  The  slogan  of  the  future  will  be:  expert  educa- 
tional diagnosis  as  a  basis  for  differentiated  programs  of 
work  to  be  given  at  differentiated  rates  of  speed  to  meet 
the  needs  of  all  kinds  and  classes  of  pupils.  Education, 
I  repeat,  is  fundamentally  a  process  of  adjustment,  and 
only  so  far  as  the  schools  succeed  in  adjusting  the  educative 
processes  to  meet  the  needs  of  the  individual  pupil  will 
they  conserve  the  mental  health  interests  of  children. 

The  coTwlusions  at  which  we  have  arrived  may  be  sum- 
marized as  follows : 

1.  It  is  impossible  scientifically  or  effectively  to 
organize  instruction  in  any  large  school  system  without 
segregating  or  grouping  together  pupils  who  are  measur- 
ably similar  either  in  respect  to  mental  normality  or  mental 
abnormality.  The  instruction  of  palpably  abnormal  with 
normal  children  is  an  injustice  to  both  the  abnormal  and 
normal  pupils,  and  to  the  teacher,  and  can  only  be 
regarded  as  a  survival  of  pedagogic  barbarism. 

2.  It  is  impossible  efficiently  to  group  together  or  to 
teach  children  who  depart  from  the  standard  of  mental 
normality  without  a  prior  scientific  diagnosis  of  each  case. 

3.  So  far  as  concerns  the  differentiation  of  mentally 
unusual  children,  the  work  of  diagnosis  requires  the 
services  of  a  technically  trained  and  experienced  psycho- 


SCHOOL  ORGANIZATION  379 

educational  examiner,  and  not  a  school  nurse,  teacher, 
principal  or  medical  inspector.  It  is  absurd  to  suppose 
that  an  amateur  is  quahfied  to  perform  the  extremely  diffi- 
cult work  of  mental  diagnosis. 

4.  Every  large  school  system  should  maintain  as  an 
essential  part  of  its  administrative  organization,  an  edu- 
cational clinic  and  laboratory  for  the  study  and  differ- 
entiation of  the  numerous  types  of  deviating  children  who 
must  receive  instruction  in  the  schools,  who  will  apply  for 
vocational  guidance  and  who  prospectively  or  actually 
come  before  the  juvenile  court.  The  schools  themselves 
should  adequately  diagnose  children  before  they  are  recom- 
mended to  the  employer  or  before  they  come  before  the 
juvenile  court. 

In  large  cities  the  clinic  should  be  established  as  an 
independent  department  of  the  schools — or  as  a  division 
of  the  department  of  special  education.  It  should  be 
closely  affiliated  with  the  training  school  for  teachers  and 
with  the  department  of  medical  inspection.  The  staff 
should  consist  of  the  following:  (1)  One  director  of  the 
psycho-educational  clinic  and  the  department  of  special 
education,  in  executive  charge  of  the  department  and 
directly  responsible  to  the  superintendent  of  schools. 
(2)  One  supervisor  of  special  education,  directly  respon- 
sible to  the  director  of  the  department.  (3)  One  or  more 
social  workers.  Teachers  or  school  nurses  may  be  used, 
provided  they  have  received  a  certain  amount  of  special 
training  for  the  work.  (4)  One  or  more  mental  testers  for 
some  of  the  routine  testing.  Adaptable  grade  teachers 
may  be  trained  for  this  work.  (5)  One  medical  man,  to 
serve  as  a  'clearing  house,'  or  general  utility  man  on  the 
medical  side.  (6)  One  or  more  clerks  for  stenographic, 
record,   tabulation    and   computation   work.      Under   this 


380    MENTAL  HEALTH  OF  SCHOOL  CHILD 

scheme  of  organization  the  cUrector  of  the  clinic  will  have 
authority  over  the  special  classes,  and  will  make  the 
influence  of  the  cHnical  work  felt  in  the  training  of 
teachers. 

5.  The  differentiation  and  specialized  training  of 
children  who  depart  from  the  average  standard  of  men- 
tality will  ultimately  prove  an  economic  gain  to  the 
community  and  a  boon  to  the  individual  pupils ;  the  con- 
servation of  the  nation's  brain  power  demands  such 
differentiation  early  in  the  school  career  of  the  child. 

6.  The  authority  of  the  schools  must  be  so  extended 
as  to  include  control  of  the  child's  out-of-school  environ- 
ment when  this  is  demoralizing  to  the  mental,  physical  or 
moral  health  of  the  child,  thereby  rendering  the  work  of 
the  schools  nugatory ;  and  also  so  as  to  include  the  right  by 
statute  to  graduate  or  transfer  anti-social  types  of  chil- 
dren into  custodial  and  industrial  colonies  where  they  may 
spend  their  lives  as  harmless,  productive  servants  and 
wards  of  the  state. 

7.  Finally,  a  word  in  regard  to  the  situation  in  Penn- 
sylvania. The  effort  to  scientifically  differentiate  and 
classify  exceptional  children  educationally  may  be  said  to 
have  originated  in  Pennsylvania.  Both  of  the  Pennsyl- 
vania universities  now  maintain  free  clinics  for  the 
psycho-educational  diagnosis  of  children.  There  is  prob- 
ably no  state  in  the  union  that  offers  superior  university 
facilities  for  rendering  this  type  of  philanthropic  service 
to  the  community.  But  the  public  schools  in  Pennsylvania 
have,  in  the  large,  failed  to  do  their  duty  in  the  establish- 
ment of  special  classes  and  special  forms  of  instruction  for 
educational  deviates.  I  make  this  statement  after  a  care- 
ful canvass  of  the  replies  made  to  a  questionnaire  which 
was    sent    last    October    to    over    1,350    school    systems 


SCHOOL  ORGANIZATION  381 

throughout  the  country  (unfortunately  even  some  of  the 
larger  systems  in  Pennsylvania  have  made  no  reply). 
Space  does  not  permit  me  to  give  the  detailed  results  of 
this  inquiry.     But  let  me  point  out  two  facts. 

First,  in  regard  to  the  character  of  the  work  being 
accomplished  in  a  state  which  has  rapidly  assumed  a  posi- 
tion of  leadership  in  the  enactment  of  constructive  educa- 
tional legislation,  namely,  New  Jersey.  State  school  laws, 
enacted  in  1911  and  1912,  now  make  it  compulsory  for 
every  local  school  board  in  New  Jersey  to  ascertain  the 
number  of  subnormal  ('three  years  or  more  below  the 
normal'),  blind  and  deaf  children  in  the  schools,  and  to 
establish  special  classes  for  the  training  of  these  types  of 
children  whenever  ten  children  of  each  type  are  found  in 
any  school  district  (provided  the  blind  or  deaf  are  not 
or  cannot  be  cared  for  in  an  institution).  No  class  may 
contain  more  than  fifteen  pupils,  and  for  each  teacher 
employed  in  one  of  the  special  classes  the  state  appro- 
priates $500.  Under  these  laws  102  classes  for  subnormal 
children,  with  an  enrollment  of  about  1,400,  had  been 
established  up  to  November  24,  1913  (according  to  infor- 
mation received  from  G.  A.  Mirick,  Assistant  Commissioner 
of  Education),  and  practically  all  of  the  large  cities  have 
estabhshed  psychological  clinics  or  their  equivalent,  or 
utilize  university  clinics.  When  may  we  hope  to  have 
similar  laws  enacted  in  Pennsylvania?  With  similar  laws 
on  the  statute  books  Pennsylvania  would  now  have  from 
500  to  1,000  special  classes  for  backward  and  feeble- 
minded children  alone.  Is  it  not  a  legitimate  function  of 
this  Association  to  urge  upon  the  legislature  the  enact- 
ment of  laws  for  the  compulsory  segregation  of  seriously 
backward  and  feeble-minded  children  in  special  classes  in 
the  public  schools? 


382    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Second,  in  regard  to  the  recent  marvelous  increase  of 
the  psychological  clinics.  According  to  questionnaire 
replies  which  have  arrived  to  date  we  now  have  the  fol- 
lowing number  of  psychological  clinics  in  the  United 
States,  more  or  less  expertly  manned:  nineteen  in  public 
schools ;  sixteen  in  university  schools  of  education  and 
departments  of  psychology ;  seven  in  medical  schools ; 
three  in  normal  schools;  five  in  public  and  private  institu- 
tions for  the  feeble-minded;  six  in  penal  and  correctional 
institutions;  two  in  juvenile  courts;  and  five  in  hospitals 
for  the  mentally  disordered ;  or  a  total  of  sixty-three.  Tliis 
does  not  include  scores  of  pubUc  schools,  institutions  and 
courts  in  which  a  few  formal  psychological  tests  (particu- 
larly the  Binet)  are  given  by  teachers  or  medical 
inspectors.  I  may  add  that  fifteen  school  systems  (exclu- 
sive of  suburban  schools  located  near  clinics)  are  utilizing, 
to  some  extent,  university  of  privately  supported  psycho- 
logical clinics,  so  that  about  thirty-five  large  school 
systems  now  attempt  more  or  less  systematically  to 
psychologically  and  educationally  diagnose  unusual  chil- 
dren. 

To  conclude:  the  schools  must  forever  renounce  the 
rigidly  inflexible  curricula  of  the  past,  which  have  proved 
veritable  pontes  asinorum  to  hundreds  of  thousands  of  chil- 
dren who  do  not  conform  to  the  assumed  typical  or  normal 
child,  and  provide,  instead,  remedial,  corrective  or  differ- 
ential instruction  designed  to  meet  the  varying  needs  of 
all  types  of  talent  and  of  all  types  of  educational 
abnormality  or  deviation. 

Some  one  has  said :  'the  sum  of  our  failures  in  education 
is  measured  by  the  number  of  our  failures  mth  individuals.' 
I  would  add :  there  cannot  be  efficient  school  organization 
or  effective  instruction  without  individual  diagnosis. 


CHAPTER  XVIII 

PUBLIC   SCHOOL  PROVISIONS   FOR  MENTALLY 
UNUSUAL  CHILDREN 

On  October  29,  1913,  a  questionnaire  on  public  school 
pro\dsions  for  mentally  exceptional  children  was  sent  to 
the  superintendents  of  public  schools  in  all  the  cities  of  the 
United  States  of  America  having  a  population  of  4,000 
and  over.  On  December  12  copies  of  the  same  question- 
naire were  again  sent  to  a  considerable  number  of  super- 
intendents in  the  larger  cities  of  the  country  who  had  not 
replied  to  the  earlier  letter.  In  some  cases  as  many  as 
three  or  four  inquiries  were  sent  before  any  response  was 
forthcoming.  As  a  result  of  these  repeated  inquiries, 
replies  were  received  from  all  the  cities  of  the  country  with 
a  population  of  100,000  and  over  (50  cities),  from  53 
per  cent  of  the  cities  of  25,000  up  to  100,000  (96  out  of 
179  cities),  and  from  156  with  a  population  of  less  than 
25,000.  In  all,  replies  were  received  from  302  cities,  or 
somewhat  less  than  one-fourth  of  the  number  addressed 
(about  1,350).' 

Special  classes  of  some  kind  are  supported  by  all  of  the 
cities  of  100,000  and  over,  except  Scranton,  Pa. ;  by  65, 
or  somewhat  less  than  68  per  cent,  of  the  96  cities  of 
25,000  up  to  100,000;  and  by  57,  or  somewhat  less  than 
37  per  cent,  of  the  156  cities  of  less  than  25,000.     It  is 

1  My  thanks  are  due  to  the  superintendents  or  their  subordinates 
who  took  pains  to  answer  the  questionnaire;  without  their  kindly 
interest  this  study  would  have  been  impossible. 


384    MENTAL  HEALTH  OF  SCHOOL  CHILD 

probably  safe  to  conclude  that  the  majority  of  the  cities 
which  failed  to  report  do  not  maintain  any  of  the  special 
classes  enumerated  in  the  questionnaire:  namely,  'classes 
for  the  feeble-minded  and  seriously  backward,  ungraded 
classes  for  giving  individual  attention  merely  to  pupils 
retarded  in  various  subjects,  epileptic,  speech-defective, 
disciplinary  or  truant,  bright,  blind,  deaf,  etc' 

The  value  of  the  replies  varied  considerably.  Some 
were  prepared  with  singular  regard  for  accuracy  and  com- 
pleteness, at  great  expense  of  time  and  labor.  Some  re- 
spondents answered  certain  questions  very  completely,  but 
others  very  incompletely  or  not  at  all.  Others  gave  rather 
incomplete  data  on  all  questions,  or  occasional  ambiguous 
answers,  with  the  result  that  it  was  sometimes  difficult  to 
determine  whether  the  classes  reported  should  be  tabulated 
as  'special  classes  for  the  feeble-minded  or  seriously  back- 
ward,' or  as  'ungraded  classes  for  giving  individual  atten- 
tion merely  to  pupils  retarded  in  various  subjects,'  or 
whether  the  psycho-educational  examinations  were  made 
by  teachers,  principals,  physicians  or  psychologists.  A  few 
superintendents  merely  sent  copies  of  their  annual  reports. 
Unfortunately,  these  seldom  gave  all  the  information  con- 
templated by  the  inquiry.  It  is  a  serious  handicap  that  we 
do  not  have  a  central  federal  Educational  Bureau  in  the 
United  States,  legally  vested  with  the  power  of  exacting 
reports  on  all  phases  of  education  from  all  the  schools  of 
all  the  states.  It  never  has  been  possible,  and  probably 
never  will  be,  through  private  inquiry  to  secure  replies 
from  all  the  public  and  private  schools  of  the  country. 
However,  the  replies  received  to  this  inquiry  are  suffi- 
ciently numerous  to  afford  a  considerable  fund  of  new  data, 
as  well  as  a  solid  basis  for  drawing  important  deductions, 
particularly  as  respects  the  type  of  classes  in  which  we 


PUBLIC  SCHOOL  PROVISIONS  385 

are  here  specially  interested  and  to  a  discussion  of  which 
most  of  this  chapter  will  be  devoted,  namely  the  classes  for 
the  feeble-minded  and  seriously  backward. 

Special  Classes  for  the  F eehle-Minded  and  Seriously 
Backward 

From  an  inquiry  made  by  the  United  States  Commis- 
sioner of  Education  in  March,  1911,  it  appeared  that  out 
of  898  cities  reporting,  99  supported  classes  'for  the 
mentally  defective'  (including  classes  for  epileptics),  and 
220  had  classes  for  'backward  children'  (see  Bulletin  No. 
461),  or  a  total  of  319.  The  latter  classes  include 
instances  in  which  'special  teachers  are  employed  to  assist 
slow  pupils.'  My  returns  indicate  that  108  cities  maintain 
special  classes  for  the  feeble-minded  and  seriously  back- 
ward (although  it  is  probable  that  some  of  these  classes  are 
not  conducted  strictly  as  special  classes),  and  111  cities 
have  ungraded  classes  for  the  retarded,  or  a  total  of  219. 
Since  my  figures  are  based  on  about  one-third  as  many 
answers  as  the  Bureau's  surve}^  but  show  68  per  cent  as 
many  classes,  it  is  very  probable  that  there  has  been  a 
material  increase  in  the  number  of  cities  supporting  special 
and  ungraded  classes.  However,  the  data  may  not  be 
strictly  comparable,  owing  to  the  difference  in  the  termin- 
ology employed  in  the  two  inquiries.  The  Bureau  made  a 
survey  of  (1)  classes  for  'defectives'  and  (2)  classes  for 
'backward  children,'  while  I  collected  data  on  (1)  special 
classes  for  the  'feeble-minded  and  seriously  backward'  and 
(2)  'ungraded  classes  for  giving  individual  attention 
merely  to  pupils  retarded  in  various  subjects.'  It  is  quite 
probable  that  many  classes  recorded  as  'special'  in  the 
Bureau's  report  did  not  provide  a  special  curriculum  of 


386    MENTAL  HEALTH  OF  SCHOOL  CHILD 

manual  work,  and  would  therefore  be  registered  as  un- 
graded classes  in  this  study. 

The  term  'defectives'  is  objectionable,  because  it  carries 
no  fixed  connotation.  Usually  when  appHed  to  school  cases 
it  is  restricted  to  children  who  are  obviously  feeble-minded. 
But  there  is  no  scientific  warrant  for  thus  restricting  its 
application,  because  pupils  who  are  seriously  backward  are 
just  as  truly  deficient  or  defective  as  the  border-line  or 
feeble-minded  cases,  but  only  less  so.  Fundamentally,  the 
difference  is  quantitative  rather  than  qualitative.  Again, 
the  practice  of  referring  to  special  classes  for  'defectives' 
is  pernicious  because  it  creates  the  mistaken  idea  that  these 
classes  are  intended  only  for  those  who  are  actually  feeble- 
minded; indeed,  the  first  public  school  special  classes 
(those  started  in  Germany)  were  organized  solely  for  the 
feeble-minded.  This  idea  has  become  almost  universally 
and  ineradicably  intrenched  in  the  habit  of  thought  of  the 
average  schoolman.  The  special  class  for  defectives  or 
deficients  always  means  to  him  the  class  for  the  feeble- 
minded. But  the  special  classes  in  the  public  schools 
should  receive  not  only  the  imbeciles  and  morons,  but  also 
the  border-line  and  seriously  backward  cases.  The  seri- 
ously backward  children  should  be  given  the  same  kind  of 
manumental  and  industrial  program  (with  modifications, 
to  be  sure,  to  meet  the  needs  of  each  case)  that  is  provided 
for  the  morons.  Negatively,  they  should  not  be  consigned 
to  the  ungraded  classes,  as  is  now  the  custom,  where  they 
are  only  given  individual  attention  and  coaching  in  the 
usual  academic  subject-matter.  What  the  seriously  back- 
ward child  needs  is  a  different  kind  of  subject-matter  and 
not  increased  drill  on  the  same  contents. 

The  study  of  my  returns  has  emphasized  again  and 
again  the  great  necessity  of  clearly  distinguishing  between 


PUBLIC  SCHOOL  PROVISIONS  387 

the  functions  of  various  kinds  of  special  classes  for  im- 
beciles, morons,  border-cases,  seriously  backward,  back- 
ward and  retarded  children.  It  is  particularly  important 
sharply  to  distinguish  between  the  so-called  'special'  and 
'ungraded'  classes.  The  following  recommendations  are 
therefore  offered  in  the  interest  of  consistency : 

First.  Special  classes  in  which  imbeciles,  morons,  border- 
line and  seriously  backward  cases  are  taught  should  be 
designated  'special  classes,'  or,  better  still,  'orthogenic'  or 
'orthophrenic  classes,'  because  the  word  special  is  generic  and 
applies  to  eight  or  ten  different  kinds  of  special  classes;  but 
only  provided  such  classes  furnish  a  special  curriculum  of 
manumental  and  industrial  work. 

Second.  The  term  'ungraded  classes'  should  be  applied  to 
classes  in  which  children  who  are  retarded  in  one  or  more 
branches  are  given  individual  attention,  singly  or  in  small 
groups  or  in  separate  classes  in  the  branches  in  which  they 
are  deficient.  These  are  essentially  coaching  classes,  giving 
intensive  attention  to  the  contents  of  the  regular  curriculum. 
No  child  should  be  assigned  to  these  classes  who  is  considerably 
deficient  in  all-round  intellectual  capacity. 

Third.  'Elementary  industrial  classes'  should  be  provided 
for  young  adolescents  (say,  from  twelve  or  thirteen  to  about 
sixteen  years  of  age)  who  are  appreciably  backward  or  who 
are  over  age  because  of  inability  to  cope  with  the  regular 
curriculum,  and  who  withal  are  industrially  inclined.  In  these 
classes  the  minimum  of  academic  work  provided  should  be 
closely  correlated  with  the  manual  and  industrial  work.  Those 
pupils  in  the  special  classes  who  meet  the  requirements  should 
be  graduated  into  these  classes  on  reaching  the  age  of  twelve 
or  thirteen. 

No  school  system  of  any  size  can  adequately  care  for 
the  different  types  of  children  on  the  minus  side  of  the 


388    MENTAL  HEALTH  OF  SCHOOL  CHILD 

curve    of    mental    and    pedagogical    distribution    without 
organizing  the  above  three  types  of  classes. 

That  the  public  schools  of  the  country  have  merely  made 
a  good  start  in  the  organization  of  work  in  this  important 
field  of  special  education  may  be  inferred  from  the  follow- 
ing percentages  of  cities  which  thus  far  do  not  support  a 
single  special  class  for  feeble-minded  and  seriously  back- 
ward children:  16  per  cent  (or  8)  of  the  cities  above 
100,000  in  population  (Kansas  City,  Mo.,  St.  Paul, 
Atlanta,  Syracuse,  Memphis,  Scranton,  Omaha,  Lowell)  ; 
60  per  cent  (or  57)  of  the  96  cities  reporting  with  a  popu- 
lation ranging  from  25,000  to  (but  not  including) 
100,000;  and  83  per  cent  (or  130)  of  the  156  cities  of  less 
than  25,000.  Certainly  every  city  with  a  school  popula- 
tion of  2,000  should  have  at  least  one  special  class.  Not 
only  so ;  in  the  cities  in  which  special  classes  have  been 
organized  the  provisions  are  wholly  inadequate.  Thus 
Baltimore,  New  Orleans,  Pittsburgh  and  San  Francisco 
support  only  one  special  class  each ;  Los  Angeles,  Spokane 
and  Denver  only  two ;  Cambridge,  Richmond  and  New 
Haven  only  three ;  Milwaukee  and  Minneapolis  only  four. 
Even  New  York's  180  classes  care  for  only  .38  per  cent  of 
the  elementary  school  population,  or  only  about  one-third 
of  the  pupils  in  that  city  who  should  be  trained  in  special 
classes.  Rochester's  twenty-nine  classes  are  said  to  furnish 
accommodations  for  only  about  15  per  cent  of  the  sub- 
normal children  of  that  city.  Some  of  these  cases,  how- 
ever, probably  belong  rather  to  ungraded  and  elementary 
industrial  classes.  No  city  anywhere  in  the  country  makes 
anything  like  adequate  provisions  for  the  segregation  of 
feeble-minded  and  seriously  backward  children.  Relatively 
to  size,  Montclair,  N.  J.,  with  eight  classes,  makes  the  best 
provision  of  any  city  in  the  country,  but  in  New  Jersey 


PUBLIC  SCHOOL  PROVISIONS  389 

evei-y  school  district  having  ten  pupils  retarded  three 
years  or  more  must,  under  the  state  law,  segregate  them  in 
special  classes  (see  p.  381). 

The  first  city  to  organize  special  classes  was  Providence 
(1896),  followed  by  Springfield,  Mass.  (1897),  Chicago 
(1898),  Boston  (1899),  New  York  (1900),  Philadelphia 
(1901),  Los  Angeles  (1902),  Detroit  and  Elgin  (1903), 
Trenton  (1905)  and  Washington,  Bridgeport,  Newton 
and  Rochester  (1906).  The  New  York  class,  which  was 
started  about  1874,  and  the  Cleveland  class,  started  in 
1879,  were  for  disciplinary  or  truant  pupils.  Although 
these  classes  undoubtedly  contained  seriously  backward  or 
feeble-minded  children,  it  is  not  apparent  that  the  program 
of  studies  consisted  of  special  class  work. 

The  enrollment  is  limited  to  15  pupils  per  class  in  forty- 
two  cities,  20  in  nine,  12  in  six,  10  in  three,  15  or  less  in 
sixty-seven  and  20  or  less  in  ninety-two  cities.  In  only 
five  cities  is  the  enrollment  permitted  to  exceed  20.  In 
some  cities  the  permissible  register  is  very  elastic,  varying 
from  7  to  20,  5  to  12,  8  to  15,  20  to  30  and  18  to  24  (see 
Table  II).  The  general  tendency  thus  appears  to  be  to 
limit  the  class  register  to  about  15 — the  limit  fixed  by  state 
law  in  New  Jersey. 

In  order  to  meet  the  demands  of  instructional  efficiency, 
no  special  class  should  ever  contain  more  than  fifteen 
imbeciles  or  morons,  or  twenty  seriously  backward  cases. 
The  chief  objection  urged  to  thus  hmiting  the  enrollment 
is  the  considerable  expense  required  to  provide  equipment 
and  expert  instruction  at  advanced  salaries  for  children 
who,  as  a  class,  can  achieve  only  mediocre  or  indifferent 
success.  It  is  argued  that  our  chief  obligation  is  to  the 
normal,  precocious  or  merely  slightly  retarded  children, 
who  may  be  trained  to  responsible  socio-industrial  service. 


390    MENTAL  HEALTH  OF  SCHOOL  CHILD 

constructive  achievement  and  leadership.  While  this 
objection  is  well  founded,  it  should  not  be  forgotten  that 
one  of  the  potent  reasons  for  segregating  the  subnormals 
is  to  free  the  regular  grades  of  driftwood  and  dead  weights. 
When  we  provide  special  opportunities  in  segregated 
classes  to  the  subnormals  we  at  the  same  time  improve  the 
working  conditions  for  the  normals.  However,  it  is  better 
to  permit  a  register  of  twenty  or  twenty-five  than  to 
dispense  entirely  with  the  special  classes  and  permit  the 
ne'er-do-wells  to  encumber  or  demorahze  the  regular 
grades.  In  the  regular  grades  these  children  are  almost 
always  irritated,  disheartened,  depressed  or  embittered  by 
the  progress  and  not  infrequently  jibes,  jeers  and  ridicule 
of  the  normal  pupils.  Here  they  soon  lapse  into  indifference 
or  become  chronic  rebels.  They  tend  to  rebel  against  the 
tension  of  the  normal  pace,  against  the  attempts  to  force 
them  to  apply  themselves  to  subject-matter  which  to  them 
is  a  meaningless  jargon  and  against  the  seeming  neglect 
or  harshness  of  teachers  who  frequently  fail  to  understand 
them  and  who,  at  best,  are  precluded  in  the  regular  grades 
from  giving  them  the  attention  which  they  require.  Be- 
cause of  their  indolence,  eccentricities,  abnormalities  and 
not  infrequent  vicious,  depraved  or  immoral  practices,  they 
often  exert  an  injurious  influence  upon  the  normal  children. 
Even  when  good-natured,  ^drtuous  and  kindly  disposed, 
they  frequently  become  the  innocent  dupes  and  cat's-paws 
of  their  wiser  but  designing  fellows.  Hence  they  should  be 
removed  from  the  regular  grades,  not  only  for  their  own 
welfare,  but  for  the  sake  of  the  normal  pupils. 

In  Germany,  the  general,  although  not  the  invariable, 
practice  is  to  establish  in  congested  centers  special  schools 
('Hilfsschule')  instead  of  special  classes.  In  London,  the 
practice  is  to  establish  centers   ('special  school  centers') 


PUBLIC  SCHOOL  PROVISIONS  391 

with  two  or  three  rooms  in  small  buildings  located  in  a 
corner  of  the  school  yard  and  separated  from  the  regular 
building  by  a  high  fence.  In  America,  the  prevailing 
tendency  is  to  organize  separate  classes  in  the  regular 
grade  buildings  rather  than  separate  schools.  From 
Table  II  it  is  not  possible  to  infer  the  exact  type  of  organi- 
zation in  effect  in  each  city.  Apparently  Dayton,  Wash- 
ington, St.  Louis  and  Salt  Lake  City  maintain  'schools,' 
although  the  schools  are  probably  not  all  housed  in  sepa- 
rate buildings.  The  objections  to  segregating  the  chil- 
dren in  detached  buildings  are :  the  grouping  of  many 
abnormal  children  throws  their  idiosyncrasies  and  abnor- 
malities into  conspicuous  relief ;  it  makes  the  cliildren  feel 
that  they  are  a  group  set  aside  from  normal  children  and 
that  they  are  essentially  different  or  inferior;  parents 
object  to  placing  the  children  apart  because  they  feel  that 
it  stigmatizes  them;  the  pupils  have  no  occasion  to  mingle 
with  the  normal  children  on  the  playground,  or  to  partake 
in  the  general  exercises,  hence  they  are  robbed  of  the 
opportunities  to  learn  imitatively  by  association  with  their 
normal  fellows ;  and  many  children  must  travel  long  dis- 
tances or  be  transported  to  the  school  at  considerable 
expense.  The  advantages  of  organizing  schools  rather 
than  single  classes  are :  it  allows  of  a  closer  grading  of  the 
pupils,  and  of  grouping  them  according  to  their  level  of 
intelligence ;  this  obviates  the  necessity  of  having  all 
grades  of  defectives  associate  together ;  it  makes  possible 
group  instruction,  and  this  makes  for  economy,  as  each 
teacher  will  be  able  to  instruct  a  larger  number  of  pupils ; 
the  central  school  permits  of  the  introduction  of  depart- 
mental work,  enabling  the  teachers  to  restrict  their  instruc- 
tion to  their  specialties,  wliich  makes  for  increased  instruc- 
tional efficiency ;  the  organization  of  schools  will  probably 


392    MENTAL  HEALTH  OF  SCHOOL  CHILD 

insure  a  better  equipment  of  didactic  materials,  as  the 
industrial,  manual  training,  kindergarten  and  other  rooms 
can  be  used  in  rotation  by  the  different  classes. 

The  best  plan  probably  is  to  establish  centers  of  three 
or  four  rooms  in  the  regular  buildings  in  congested  sections 
and  separate  rooms  in  the  regular  grade  buildings  in  the 
less  populous  districts.  Moreover,  the  larger  cities  may 
very  well  consider  the  advisability  of  establishing  a  farm 
residential  institution  near  the  city  limits  for  the  industrial 
training  of  educable  feeble-minded  indigent  children.  The 
majority  of  these  children  after  finishing  their  course  of 
training  should  be  transferred  at  the  age  of,  say,  fifteen 
or  sixteen  years  to  state  colonies,  where  they  should  be 
obliged  to  utilize  in  self-supporting  occupations  the  skill 
which  they  have  developed.  The  city  residential  institu- 
tion should  prepare  them  for  efficient  service  in  colony  life. 

The  Examination  of  F eehle-Minded  and  Backward 
Children 

The  practice  of  requiring  some  kind  of  special  examina- 
tion before  a  cliild  may  be  assigned  to  a  special  class  is 
becoming  well-nigh  universal.  The  103  cities  in  Table  III 
so  reported  except  Elgin,  Washington,  Pa.,  Columbus 
and  New  Orleans ;  the  latter  two,  however,  give  the  exami- 
nation after  admission.  The  following  cities  failed  to 
answer  this  question:  Pittsburgh,  Bridgeport,  Fall  River, 
Portland,  Worcester,  Aurora,  Ft.  Wayne  and  Stonington, 
Conn.  It  is,  of  course,  impossible  to  state  how  thorough 
or  valuable  these  admission  examinations  are. 

Eighty-one  of  the  cities  provide  a  medical  examination, 
two  do  not,  while  twenty-one  failed  to  answer  the  question 
(see  Table  III). 


PUBLIC  SCHOOL  PROVISIONS  393 

Fifty-nine  (or  57  per  cent)  of  the  schools  give  educa- 
tional tests,  while  the  other  forty-four  leave  this  question 
unanswered.  It  is  impossible  from  the  data  to  determine 
the  character  of  the  educational  examination,  but  it  is 
improbable  that  any  standardized  pedagogical  efficiency 
tests  have  been  used  to  any  extent.  The  tests  given  are 
probably  only  the  ordinary  examination  questions  of  the 
schools,  or  the  school  record  of  the  child. 

That  the  psychological  study  of  candidates  for  special 
classes  is  rapidly  becoming  universal  is  apparent  from  an 
examination  of  Table  III.  Eighty-four  (or  81  per  cent) 
of  the  103  cities  report  that  psychological  tests  are  given 
either  by  employees  of  the  school  boards  or  by  outside 
agencies.  This  includes  all  of  the  19  cities  of  250,000 
population  and  over,  all  the  cities  except  5  (or  76  per 
cent)  of  the  21  with  a  population  of  100,000  to  250,000 
(including  Indianapolis),  all  except  12  (or  68  per  cent) 
of  the  38  cities  between  25,000  and  100,000  (Aurora,  how- 
ever, brings  some  children  to  Chicago  for  examination), 
and  all  except  2  (or  92  per  cent)  of  the  25  cities  of  less 
than  25,000.  Psychological  testing  is  thus  relatively  more 
prevalent  in  the  groups  of  cities  having  the  largest  and 
smallest  populations.  The  names  of  the  cities  which  do  or 
do  not  conduct  psychological  testing  may  be  obtained  from 
the  table. 

While  this  is  an  extremely  creditable  showing,  particu- 
larly in  view  of  what  it  portends  for  the  future,  it  is  neces- 
sary to  emphasize  that  the  psychological  testing  in  most  of 
the  cities  is  exceedingly  meager  and  crude,  being  conducted 
by  teachers,  principals,  educators,  psychologists  and 
physicians  who  are  not  specialists  on  the  physiology, 
psychology  and  pedagogy  of  feeble-minded,  backward  or 
other  types  of  mentally  abnormal  cliildren.     This  fact  is 


394    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

revealed  by  an  examination  of  the  columns  in  the  table 
giving  the  extent  of  the  psychological  examination,  and 
the  extent  of  the  technical  preparation  and  professional 
affihation  of  the  psychological  examiners,  (The  answers 
supplied  to  these  questions  were  in  many  cases  extremely 
ambiguous,  evasive  or  unsatisfactory.)  Fifty-two  cities 
report  that  the  testing  is  confined  entirely,  or  almost 
entirely,  to  the  Binet  tests.  Twenty-four  respondents 
failed  to  answer  the  question.  It  is  entirely  probable,  I 
believe,  that  at  least  seventy-five  (or  72  per  cent)  of  the 
103  cities  do  not  go  beyond  the  Binet  and  form-board 
tests.  In  some  cities,  less  than  this  is  attempted.  In  only 
twenty-one  cities  is  it  safe  to  infer  that  the  psychological 
testing  exceeds  this  minimum.  Of  the  seven  cities  of 
less  than  100,000  which  report  giving  additional  tests,  it 
is  probable  that  only  two  or  three  attempt  anything 
approaching  an  exhaustive  examination. 

But  more  important  than  the  extent  of  the  formal 
testing  is  the  adequacy  of  the  preparation  and  the  experi- 
ence of  the  psychological  examiners.  Immeasurably  more 
important  than  the  tests  is  the  'man  behind  the  gun,'  An 
analysis  of  the  table  with  respect  to  the  professional  affili- 
ations and  attainments  of  the  examiners,  including  those 
employed  both  by  the  schools  and  by  outside  agencies — a 
total  of  115  examiners — shows  that  52  are  special  class 
teachers,  11  supervisors  of  special  classes  or  principals,  4 
superintendents  of  schools,  5  alienists  or  neurologists,  22 
medical  inspectors  or  physicians,  8  psychologists  and  13 
clinical  psychologists  (restricting  the  application  of  the 
latter  term  to  those  only  who  are  trained  experts  on  the 
psychology  and  pedagogy  of  mentally  unusual  children). 
It  should  be  said  that  when  the  examinations  were  reported 
to  be  made  b}^  the  medical  inspector,  special  teacher  and 


PUBLIC  SCHOOL  PROVISIONS  395 

principal,  each  was  separately  counted  in  the  above  sum- 
mary, although  it  is  possible  that  in  many  of  these 
reported  instances  only  the  special  teacher  made  the 
psychological  examination. 

These  data  point  to  various  interesting  conclusions : 

1.  In  the  vast  majority  of  cases  the  psychological 
testing  (and  possibly  also  the  diagnoses)  of  mentally 
exceptional  children  in  the  schools  is  made  by  Binet 
testers — in  other  words,  by  amateurs.  This  includes  all 
the  special  teachers  and  the  majority  of  the  super^dsors, 
superintendents  and  medical  inspectors.  After  a  careful 
scrutiny  of  the  quahfications  of  the  examiners,  I  am  forced 
to  the  conclusion  that  not  more  than  thirty  psychologists, 
physicians,  alienists  and  educators  occupy  a  status  other 
than  that  of  the  Binet  tester.  Accordingly  74  per  cent  of 
the  testing  is  done  by  Binet  testers. 

2.  The  extent  of  preparation  of  the  great  majority  of 
the  Binet  testers  (cf.  data  given  in  the  column  in  the 
table  entitled  'extent  of  preparation  of  psychological 
examiners')  consists  in  ha\'ing  taken  nonnal  school,  col- 
lege or  university  courses  in  the  usual  branches  of  educa- 
tion and  psychology,  and  a  summer  course  on  mental  tests 
and  on  feeble-minded  children ;  or  in  ha^^ng  taken  a 
regular  medical  course  and  then  reading  literature  on 
feeble-minded  and  backward  children,  learning  to  give  the 
Binet  system,  or  paying  a  visit  to  a  psychological  clinic. 
Even  if  we  concede  that  it  is  possible  thus  to  prepare 
psycho-educational  testers,  the  conclusion  remains  true: 
that  such  testers  are  not  expert  psycho-educational  diag- 
nosticians, and  that  to  prepare  expert  psycho-educational 
diagnosticians  requires  three  or  four  years  of  technical 
training  and  clinical  experience. 


396    MENTAL  HEALTH  OF  SCHOOL  CHLLD 

3.  The  vast  majority  of  psychological  examiners  are 
educators.  By  including  among  the  educators  the  clinical 
psychologists,  psychologists,  teachers,  supervisors,  prin- 
cipals and  superintendents  (a  total  of  eighty-eight),  and 
among  the  physicians  the  medical  inspectors,  alienists  or 
neurologists  (a  total  of  twenty-seven),  it  appears  that  77 
per  cent  of  the  examiners  are  educators  and  only  23  per 
cent  are  physicians.  This  represents,  I  beheve,  a  true 
appreciation  of  what  the  problem  of  mental  exceptionality 
involves.  The  psychological  diagnosis  of  school  children 
cannot  be  divorced  from  their  educational  diagnosis.  It 
is  essentially  pyscho-educational  in  its  nature.  Its  aim  is 
essentially  educational,  the  correct  pedagogical  classifica- 
tion and  differential  pedagogical  training  of  the  child. 
Therefore  the  directing  authority  in  the  diagnosis  and 
training  of  educationally  exceptional  children  must  be  the 
educationist  rather  than  the  sociologist,  physician,  experi- 
mental psychologist,  biologist  or  heredity  worker.  This  is 
no  more  exclusively  a  medical  problem  (except  in  certain 
cases)  than  it  is  exclusively  a  social,  heredity  or  psycho- 
logical problem.  But  by  'educationist'  I  do  not  mean  the 
ordinary  teacher,  principal,  superintendent,  or  child, 
experimental  or  educational  psychologist ;  I  refer  to  the 
technically  trained  psycho-educational  examiner  who  pos- 
sesses the  qualifications  described  on  pp.  114  f.,  132  f., 
157  f.,  210  f.,  and  216  f. 

Moreover,  that  the  psychological  examination  of  school 
children  is  already  regarded  as  a  function  of  the  schools 
is  indicated  by  the  fact  that  in  the  overwhelming  majority 
of  cities  the  examinations  are  now  conducted  in  the  edu- 
cational divisions  rather  than  in  the  departments  of 
medical  inspection  or  in  the  boards  of  liealth.     Sixty-four 


PUBLIC  SCHOOL  PROVISIONS  397 

cities  conduct  the  examinations  in  the  educational  divisions 
of  the  schools  and  only  twenty-two  in  the  divisions  of 
medical  inspection.  The  two  divisions  conduct  the  exami- 
nations jointly  in  some  cities.  Moreover,  at  least  seven 
(possibly  fourteen)  of  the  departments  of  medical  inspec- 
tion are  under  the  control  of  the  boards  of  education,  so 
that  82  per  cent  of  the  work  is  supported  by  educational 
boards  (exclusive  of  the  cooperative  work  by  outside 
agencies).  These  figures  indicate  a  growing  conviction 
that  this  work  should  be  placed  directly  under  the  execu- 
tive control  of  the  superintendent  of  instruction. 

The  best  indication  that  the  schools  will  not  long  be 
content  with  crude  or  amateurish  psycho-educational 
diagnoses  is  the  remarkable  growth  of  the  psychological  or 
psycho-educational  clinics  in  the  schools.  Laboratory 
clinics  have  been  established  in  the  following  schools :  Chi- 
cago, 1898;  Rochester,  1907;  New  York,  1908;  Provi- 
dence, Oakland,  Hibbing  and  Cincinnati,  1911 ;  Grand 
Rapids,  Seattle,  Philadelphia,  Springfield,  Mass.  (sup- 
ports a  psychologist  on  part  time).  New  Orleans  and 
Milwaukee  (temporarily  discontinued),  1912;  Buffalo, 
Washington,  Albany,  Los  Angeles  and  Trenton,  1913,  and 
Detroit,  1914  (supports  a  consulting  psychologist  on  part 
time) — a  total  of  nineteen  public  school  clinics.^ 

2  The  first  twelve  psychological  clinics  established  in  any  kind  of 
institution  (including  the  institutional  psychological  laboratories)  are, 
in  tlie  order  of  organization:  University  of  Pennsylvania,  1896;  Chi- 
cago Public  Schools  and  Minnesota  School  for  the  Feeble-Minded  and 
Colony  for  Epileptics,  1899  (discontinued  but  reestablished  in  1910) ; 
McLean  Hospital,  Waverley,  Mass.,  1904;  The  Training  School  at 
Vineland,  N.  J.,  1906;  Rochester  Public  Schools  and  Government 
Hospital  for  the  Insane,  Washington,  D.  C,  1907;  Colorado  State 
Teachers'  College,  Greeley,  1908;  University  of  Washington,  Univer- 
sity of  Minnesota,  Lincoln  State  School  and  Colony  of  Illinois,  and 


398    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Several  other  cities  already  have  good  rudimentary 
clinics,  and  others  are  ready  to  organize  clinics.^  It  is  safe 
to  prophesy  that  witliin  the  next  five  or  ten  years  every 
city  with  a  population  of  100,000  and  over  will  have  its 
school  psycho-educational  clinic,  and  smaller  cities  will 
make  some  provision  for  the  more  adequate  psychological 
examination  of  their  mentally  exceptional  school  children. 

All  of  the  existing  clinics  are  under  the  control  of  the 
superintendent  of  instruction  except  four,  two  of  these 
being  administered  by  the  board  of  health  (Buffalo  and 
Providence),  one  by  the  department  of  medical  inspection 
(Philadelpliia)  and  one  by  a  municipal  university  (Cin- 
cinnati). Six  of  the  directors  of  these  clinics  are  clinical 
psychologists.  However,  by  adding  two  medical  directors 
who  have  considerable  psychological  training  and  extensive 
experience  with  the  feeble-minded,  and  three  psychologists, 
the  number  may  be  increased  to  eleven.  Only  two  or  three 
clinics  are  in  charge  of  medical  inspectors,  one  is  in  charge 
of  an  alienist,  and  three  are  in  charge  of  Binet  testers. 

Juvenile  Psychopathic  Institute,  Chicago,  1909.  Psychological  testing 
was  begun  on  a  small  scale  in  the  Los  Angeles  public  schools  in 
1895,  but  a  psychological  clinic  was  not  established  as  an  independent 
division  until  July,  1913. 

3  On  April  14,  1914,  the  Board  of  Education  of  the  city  of  St.  Louis 
authorized  the  establishment  of  a  'psycho-educational  clinic,'  as  an 
independent  division  in  the  department  of  education,  and  appointed 
the  writer  as  the  first  'director.'  The  clinic  wiU  be  located  on  the 
grounds  of  the  Harris  Teachers  College,  with  which  it  will  be  closely 
affiliated.  The  director  of  the  clinic  will  have  administrative  super- 
vision of  the  clinical  and  educational  work  with  mentally  unusual 
children.  The  actual  work  of  class  supervision  will  be  in  charge  of 
a  special  supervisor,  working  under  the  directions  of  the  clinic.  The 
director  will  offer  courses  at  the  Harris  Teachers  College  on  mentally 
exceptional  children.  The  form  of  organization  adopted  by  St.  Louis 
corresponds,  in  the  main,  to  the  plan  suggested  on  p.  375. 


PUBLIC  SCHOOL  PROVISIONS  399 

Number  of  Psychological  Clinics  in  All  Kinds  of 
Institutions. 

In  public  schools,  as  above 19 

In  universities  (see  p.  57),  including  the  Psycho- 
pathic Laboratory  in  the  School  of  Education, 

University  of  Chicago 17 

In  medical  schools  (see  p.  58) 7 

In  normal  schools  (seep.  58) 3 

In  Girard  College 1 

In  institutions  for  the  feeble-minded  and  epileptic 
(including  Lapeer,  which  has  a  consulting  psy- 
chologist, see  p.  70f.) 6 

In  hospitals  for  the  insane  (these  clinics  perhaps  are 
psychological  laboratories  rather  than  psycho- 
logical clinics,  see  p.  70) 5 

In  penal  and  correctional  institutions  (see  p.  78)      .  6 

New  York  Probation  and  Protective  Association        .  1 

In  juvenile  courts  (see  p.  74) 2 

In  municipal  criminal  courts  (Boston  and  Chicago)  2 

In  immigrant  stations  (Ellis  Island)        ....  1 

Total 70 

(According  to  recent  press  reports,  psychological 
examinations  are  also  given  in  clinics  established  in  con- 
nection with  the  criminal  branch  of  the  municipal  court  in 
the  city  of  Cleveland  and  in  connection  with  the  juvenile 
court  in  Philadelphia.  The  Ohio  Board  of  Control  for 
state  institutions  is  erecting  a  central  observation  cottage, 
which  will  serve  as  a  clearing-house  for  children  who  are 
to  be  sent  to  institutions.  Here  defectives  and  delinquents 
of  doubtful  mentality  will  be  given  a  mental  and  physical 
examination  before  being  placed  in  an  institution.  The 
Board  is  given  the  power  to  examine  and  transfer  cases. 
No  special  legislative  appropriation  has  yet  been  made  for 


400    MENTAL  HEALTH  OF  SCHOOL  CHILD 

this  clearing-house  which,  evidently,  will  contain  a  psycho- 
logical clinic.) 

Seventy-five  cities,  or  75  per  cent  of  the  cities  tabulated 
in  Table  IV,  pay  increased  salaries  to  teachers  of  back- 
ward and  feeble-minded  children,  8  per  cent  give  no 
increase,  3  per  cent  of  the  answers  are  ambiguous,  and  13 
per  cent  failed  to  reply  to  the  question.  One  city  gives  an 
initial  increase  of  $300 ;  two  cities  an  increase  of  $250 ; 
one,  $240;  eight,  $200;  one,  $160;  three,  $150;  thirty- 
one,  $100;  one,  $75;  one,  $60,  and  thirteen,  $50.  New 
York  pays  a  minimum  of  $860  and  a  maximum  of  $1,820, 
with  a  $100  annual  increase.  The  advance  most  frequently 
given  is  thus  $100  a  year,  followed  by  $50  and  $200. 

The  justification  for  raising  the  salaries  of  special-class 
teachers  is  twofold.  First,  the  arduous  nature  of  the  work. 
I  am  not  certain,  however,  that  this  point  is  well  taken, 
for,  while  subnormal  children  require  far  more  drill, 
individual  attention  and  patient  care  than  normal  children, 
the  special  teacher  is  relieved  of  the  drudgery,  monotony 
and  formalism  incident  to  mass  instruction  and  the  dis- 
cipline of  large  numbers  of  children.  Many  teachers  Avho 
desire  to  escape  from  the  lock-step  of  class  work  will 
regard  the  opportunities  of  doing  individual  work  with 
small  numbers  as  sufficient  compensation  in  itself. 

Second,  the  specialized  preparation  required  by  the 
work.  The  teacher  of  the  special  class  must  be  an  expert ; 
she  must  be  able  to  'psychologize'  each  pupil  and  individ- 
ualize instruction ;  she  must  be  able  to  grasp  the  essen- 
tials of  the  diagnosis  submitted  with  cases  on  admission, 
so  that  she  can  adapt  treatment  to  individual  needs ;  she 
must  be  able  to  observe  scientifically,  so  that  she  can 
modify  and  adapt  her  methods  to  the  developmental  needs 
of  each  pupil;  she  must  be  thoroughly  grounded  in  cor- 


PUBLIC  SCHOOL  PROVISIONS  401 

rective  pedagogics ;  in  a  word,  she  must  be  an  expert  in 
orthophrenics.  But  no  teacher  can  be  considered  an  expert 
in  this  field  who  has  not  pursued  extended  technical  courses. 
A  professional  course  pursued  during  a  summer  term 
suffices  merely  to  lay  a  good  foundation. 

That  school  administrators  are  gradually  becoming 
convinced  that  no  one  should  be  appointed  to  teach  a 
special  class  who  has  not  made  a  special  study  of  the 
problems,  is  apparent  from  an  examination  of  Table  V. 
Seventy-two,  or  70  per  cent  of  the  102  cities  tabulated, 
answered  in  the  negative  (or  gave  data  which  seemed  to 
justify  a  negative  answer)  the  question,  'Do  you  appoint 
teachers  of  special  classes  for  the  feeble-minded  and  seri- 
ously backward  who  have  not  received  special  prepara- 
tion .f"  However,  this  figure  is  probably  slightly  too  high, 
because  it  includes  cities  which  -propose  in  future  to 
require  special  training  as  the  ehgibility  condition  for 
appointment,  and  cities  which  expect  teachers  to  take  a 
training  course  after  instead  of  before  appointment  (this 
may  be  good  for  the  teacher,  but  it  is  bad  pedagogy  and 
hard  on  the  pupils).  Moreover,  gratifying  as  these  results 
are,  it  should  be  stated  that  the  standards  of  what  con- 
stitutes 'special  preparation'  for  this  work  are  still  quite 
vague  and  fluid.  Shall  we  regard  as  'specially  trained' 
teachers  who  have  taken  a  kindergarten  course,  or  who 
have  merely  taught  young  children,  or  who  have  taken  or 
taught  a  little  industrial  work,  or  who  have  merely  observed 
the  work  of  a  special  class  for  a  few  weeks.?  Hardly.  The 
training  which  teachers  need  for  this  work  is  just  as 
specific,  precise,  detailed  and  extended  (in  fact,  more 
extended)  as  the  training  needed  to  become  an  expert 
kindergartner,  or  manual  or  domestic  arts  teacher.  New 
York  City  is,  I  beheve,  the  only  city  in  the  country  which 


402    MENTAL  HEALTH  OF  SCHOOL  CHILD 

gives  a  special  eligibiKty  examination  to  all  candidates  for 
appointment  to  a  special  class  for  feeble-minded  and 
seriously  backward  children. 

Ungraded  Classes 

About  102,  or  33  per  cent  of  the  302  cities  reporting, 
maintain  ungraded  classes.  This  is  exclusive  of  one  city 
in  which  the  principals  give  a  little  attention  to  slow  pupils, 
and  of  a  few  cities  in  which  the  classes  are  di^^ded  into  slow, 
medium  and  fast  divisions,  and  in  which  the  slow  pupils  are 
given  industrial  work.  But  it  includes  cities  in  which 
teachers  give  individual  instruction  before,  during  and 
after  school  hours,  during  the  regular  terms  or  the  summer 
term  only,  to  pupils  separately,  or  in  ungraded  classes,  or 
in  the  regular  grades,  in  small  groups  or  in  unlimited 
numbers,  by  substitute,  assisting,  unassigned,  ungraded  or 
regular  teachers.  It  includes  cities  in  which  the  instruc- 
tion is  available  to  the  slow  pupils  in  all  grades,  or  is  limited 
to  those  in  the  first  three  or  four  grades  or  to  those  in  the 
seventh  and  eighth  grades.  It  is  evident  from  the  returns 
that  the  types  of  ungraded  class  organization  which  obtain 
throughout  the  country  have  little  in  common  except  the 
element  of  coaching  or  individual  attention.  It  is  also 
evident  from  many  of  the  replies  that  the  function  of  these 
classes  is  frequently  confused  with  the  function,  on  the  one 
hand,  of  the  elementary  industrial  classes  and  with  the 
function,  on  the  other  hand,  of  the  special  (orthogenic) 
classes.  It  is  quite  clear  to  mj^  mind  that  the  ungraded 
class  has  become  the  dumping-ground  for  the  misfits  of 
the  schools,  just  as  the  special  class  once  was  (and  still  is 
in  many  places)  the  dumping-ground  for  the  flotsam  and 
jetsam  of  the  schools.  Here  one  finds  all  types  and  all 
grades    of    deviating    children,    from    the    imbeciles    and 


PUBLIC  SCHOOL  PROVISIONS  403 

morons  to  the  'motor  minded'  or  industrially  inclined.  It 
has  been  my  fortune  to  examine  a  considerable  number  of 
pupils  who  have  been  consigned  by  the  educational  authori- 
ties to  the  ungraded  classes  because  they  'were  merely 
temporarily  retarded  on  account  of  absence,  sickness  or 
transfer  and  therefore  needed  only  individual  attention 
from  the  ungraded  teacher.'  I  have  frequently  marveled 
over  the  blundering  diagnoses  which  have  consigned 
morons  and  seriously  backward  children  to  the  coaching 
classes,  as  well  as  children  who  should  be  given  academic 
work  almost  entirely  in  correlation  with  elementary  indus- 
trial training.  There  is  no  justification  for  the  supposi- 
tion that  psycho-educational  diagnosis  is  necessary  only 
for  the  extreme  abnormal  types,  and  not  for  the  children 
who  grade  nearer  the  normal.  The  correct  diagnosis  of 
some  of  the  latter  is  no  mean  task.  There  is  urgent  need 
for  a  thoroughgoing  study  of  all  aspects  of  ungraded  class 
organization.  What  is  the  most  efficient  type  of  organi- 
zation.'* Should  the  class  merely  be  divided  into  slow, 
normal  and  fast  divisions,  and  each  division  be  instructed 
by  the  regular  teachers,  or  should  the  slow  pupils  be 
grouped  together  in  a  separate  ungraded  class,  or  should 
they  be  taken  out  occasionally,  singly  or  in  small  groups, 
and  be  given  special  attention  by  ungraded  teachers.'' 
What  should  be  the  enrollment  of  the  ungraded  class.'' 
The  practice  varies  considerably.  In  twelve  of  the  cities 
tabulated  the  register  is  20 ;  in  eleven,  25 ;  in  nine,  15 ;  in 
four  each,  20  to  25,  and  15  to  20 ;  in  three,  24 ;  in  two  each, 
20  to  24,  15  to  18,  12,  and  30.  In  others  it  varies  from 
15  to  70,  20  to  30,  5  to  20,  5  to  12,  4  to  9,  3  to  8  and  1 
to  4  (the  latter  figures  probably  refer  to  the  size  of  groups 
instead  of  classes).  In  thirty-eight  cities  the  register  is 
between  20  and  30  (inclusive),  in  thirty  between  15  and 


404    MENTAL  HEALTH  OF  SCHOOL  CHILD 

20  (inclusive),  and  in  eight  less  than  14.  What  is  the  true 
function  of  the  ungraded  class?  What  are  the  practical 
results  of  ungraded  work?  What  types  of  pupils  are 
really  benefited  by  individual  coaching  in  the  regular 
academic  branches?  What  are  the  qualifications  required 
by  the  'ungraded'  teacher?  What  special  preparation 
does  she  require?  It  is  obvious  that  a  teacher  who  is 
unable  to  study  each  child,  to  unearth  the  causes  of  his 
peculiar  pedagogical  handicaps,  to  psychologize  the  child 
and  individualize  the  instruction,  has  little  place  in  the 
ungraded  room.    All  these  questions  deserve  careful  study. 

From  the  following  tabulation  it  appears  that  the 
feeble-minded  and  backward  classes  are  relatively  more 
numerous  in  the  larger  cities  (above  25,000),  while 
ungraded  classes  are  relatively  more  numerous  in  the 
smaller  cities  (below  25,000)  : 

Percentages  of  the  302  cities  maintaining 


cial  Classes 
Per  cent 

Population 

Ungraded  Classes 
Per  cent 

84 

over  100,000 

74 

43 

25,000  to  100,000 

35 

17 

under  25,000 

20 

This  is  probably  not  due  to  the  fact  that  there  are  rela- 
tively more  feeble-minded  and  seriously  backward  pupils 
in  the  larger  cities,  but  is  due  to  the  fact  that  the  smaller 
cities  have  not  yet  become  thoroughly  alive  to  the  admin- 
istrative educational  problems  affecting  these  children. 
The  alleged  explanation  that  there  are  not  enough  seri- 
ously deficient  children  in  smaller  cities  (say,  conserva- 
tively, in  cities  of  10,000  and  over)  to  make  up  a  class,  is 
without  foundation. 

For  data  bearing  on  the  other  types  of  special  classes 
the  reader  is  referred  to  Tables  VII  to  XV. 


TABLE  II 
Classes  for  the  Feeble-Minded  and  Seriously  Backward 


Cities  of  500,000  and  over 


City 

Year 
Started 

No.  of 

Pupils 

per  Class 

No.  of 
Classes 

Types  of  Pupils,  or  Character 
of  Class 

7  to  20 
15 

20 

10  to  20 

15 

16  ave. 

15 

15 

1 
30 

50 
17 
180 
90 
1 

34 

Mental  defectives 

Boston,  Mass 

Chicago,  111 

Cleveland,  O 

New  York,  N.Y 

Philadelphia,  Pa 

Pittsburgh,  Pa 

St.  Louis,  Mo 

1899 

1898 
1879 
1900 
1901 
1912 

1907-08 

Mental  defectives  of  the  im- 
provable type 

Subnormal  and  backward 

Classes  for  backward  children 

F.-M.  and  seriously  backward 

Orthogenic  classes 

F.-M.  and  backward;  more  in 
process  of  organization 

480  pupils  in  13  'special  schools' 
for  the  backward  and  defi- 
cient 

Cities  of  250,000  and  less  than  500,000 


Buffalo,  N.Y 

Cincinnati,  O 

Detroit,   Mich 

Jersey  City,  N.J. 


Los  Angeles,  Cal. . . 
Milwaukee,  Wis. . . . 
Minneapolis,  Minn. 

Newark,  N.  J 

New  Orleans,  La.. . 


San  Francisco,  Cal. 


Washington,  D.  C. 


1909 
1909 
1903 
1911 

1902 
1908 
1912 
1910 
1910 


15 
15 
15 
15 

12 
12 
15 
15 
14-15 


Mentally  subnormal 

F.-M. 

F.-M.  classes 

For  those  '3  years  below  nor- 
mal' 

Defectives 

Subnormal 

F.-M. 

Defectives  (F.-M.) 

'An  auxiliary  class  (ungraded) 
of  exceptional  children' 

'Ungraded  class  for  defect- 
ives. Hope  to  organize  a 
school' 

F.-M.  and  seriously  back- 
ward ;  4  colored  ;  10  white 


Cities  of  100,000  and  less  than  250,000 


Albany,  N.Y 

Birmingham,  Ala. 
Bridgeport,  Conn. 
Cambridge,  Mass. 

Columbus,  O 

Dayton,  O 

Denver,  Col 

Fall  River,  Mass.. 


Grand  Rapids,  Mich. 
Indianapolis,  Ind. . . . 

Louisville,  Ky 

Lowell,  Mass 


Nashville,  Tenn. 


New  Haven,  Conn. 
Oakland,  Cal 


1906 
1913 
1909 
1911 
1911 
1913 

1910 
1907 
1913 


1913 
1911 


12-20 

10 

20 

15 

15-20 


10 

15 

12-15 
16-18 
12-14 


(?)40 


Classes  for  F.-M.  and  seriously 
backward 

F.-M. 

Defective 

Deficient  children 

'Slow  and  mentally  defective' 

One  school  for  defectives 

Mentally  defective 

At  present  only  special  obser- 
vation classes 

F.-M. 

TNvo  schools  for  defectives 

Defectives 

Send  abnormals  to  state 
school  for  F.-M. 

Retarded  (?);  4  teachers  in  1 
bldg. 

'Subnormal' 

Subnormal 


Cities  of  100,000  and  less  than  250,000  (continued) 


City 

Year 
Started 

No.  of 

Pupils 

per  Class 

No.  of 
Classes 

Types  of  Pupils,  or  Character 
of  Class 

Paterson,  N.  J 

Portland,  Ore 

1912 

15 

8-12 
18 
15 
15 
12 
15 

4 

Mentally  deficient 

Providence,  R.  I 

1896 
1910-11 
1906 
1910 
1911 
1913 
1910 

8 

3 

29 

10 

2 

F.-M. 

Rochester,  N.  Y 

Seattle,  Wash 

Spokane,  Wash 

Subnormal 
F.-M. 
Defective 
Backward 

Toledo,   O 

15 
18-24 

15 
16 

F.-M.  and  seriously  backward 
Classes  for  defective  and  back- 

ward 

Cities  of  25,000  and  less  than  100,000 


Allentown,  Pa. 
Altoona,  Pa. . . 


Auburn,  N.  Y.  . . 

Aurora,  111 

Bayonne,  N.  J.. . 
Brockton,  Mass. 
Camden,  N.  J... 


Chester,   Pa. 
Decatur,   111. 


Elgin,  ID 

Elizabeth,  N.  J., 

Erie,  Pa 

Ft  .Wayne,  Ind. 

Harrisburg,  Pa. 
Houston,  Tex.. 


Kalamazoo,  Mich. 


Lancaster,  Pa 

Little  Rock,  Ark.... 

Lynn,    Mass 

Maiden,   Mass 

Mt. Vernon,  N.  Y.  ... 
New  Britain,  Conn. 
New  Rochelle,  N.Y. 

Newton,  Mass 


Niagara  Falls,  N.  Y. 

Passaic,  N.J 

Perth  Amboy,  N.  J. 
Reading,  Pa 


Saginaw,  Mich 

Salt  Lake  City,  U.. 

Schenectady,  N.  Y. 
Somerville,  Mass.. . 
Springfield,   Mass.. 

Superior,  Wis 

Tacoma.Wash 

Trenton, N.J 

Waltham,  Mass 


W.  Hoboken,  N.  J. 


1910 
1914 

1911 
1912 
1911 


1912 
1912 


1903 
1909 
1910 


1910 
1908 


1912 
1912 
1909 
1909 
1913 
1907 


1906 

1912 
1907 
1912 
1908 

1907 


1912 
1910 
1897 
1911 
1910 
1905 


1912 


15 
8-15 

10-12 
15-18 

15 
20-30 

15 

17 
4 


20 
14 

8-12 

10-12 
11 
16 
15 
17 
12 

10-20 

40 

15-20 
15 
15 
20 

10-15 


20 
15 
15 
5-12 
10 
10-15 


F.-M. 

Expect  to  start  a  class  for 
'mental  defectives'  in  1914 

F.-M. 

F.-M.  and  speech  defectives 

F.-M. 

Defectives 

Institutional  children  and 
mentally  weak 

F.-M.  and  backward 

Classes  for  F.-M.,  slow,  deaf, 
disciplinary  and  speech  de- 
fective 

F.-M.  and  retarded 

Mentally  inferior 

One  school  for  F.-M. 

State  School  takes  care  of  de- 
fectives 

F.-M.  and  seriously  backward 

F.-M.,  seriously  backward, 
speech  defective 

F.-M.  and  seriously  back- 
\vard 

Mentally  defective 

F.-M. 

F.-M. 

F.-M. 

Defectives 

Mental  defectives 

Classes  for  F.-M.  and  seriously 
backward 

Seriously  backward ;  4  teach- 
ers 

Subnormal 

Mentally  defective 

F.-M. 

Seriously  backward,  including 
deaf,  blind,  epileptic 

Mentally  defective 

One  hundred  in  one  atypical 
school 

F.-M. 

F.-M. 

Mentally  defective 

Mentally  defective 

Mentally  defective 

Mentally  subnormal 

Utilize  Waltham  State  School 
for  F.-M. 

F.-M. 


Cities  less  than  25,000 


City 


Year 
Started 


No.  of 

Pupils 

per  Class 


No.  of 
Classes 


Types  of  Pupils,  or  Character 
of  Class 


AsheviUe,  N.  C 

Plan  to  start  classes 

Bloomfield,  N.J 

15-21 

2 

For  those  '3  or  more   years 

below  class' 

Englewood,  N.J 

1910 

15 

1 

For  those   '3  years    or  more 
below  normal' 

Everett,  Wash 

1911 

15 

1 

Mentally  deficient 

Goldsboro,  N.  C 

1913 

20 

1 

Mentally  deficient 

Hackensack,  N.  J 

1911-12 

15 

3 

Mentally  defective 

Hempstead,  N.  Y 

1913 

20 

Classes  for  F.-M.  and  serious- 

ly backward 

Hibbing,  Minn 

1913 

15 

1 

F.-M. 

Hoquiam,   Wash 

1909 

12 

1 

Subnormal 

Lakewood,  O 

1913 

12 

1 

For  'children  retarded  4  years 
pedagogically' 

Leavenworth,  Kan 

1911 

15 

Groups  formed  in  each  school 

for  exceptional  children 

Leominster,  Mass 

1912 

15-20 

1 

Seriously  backward 

Long  Branch,  N.  J 

1912 

15 

2 

Subnormal 

Mason  City,  la 

1911 

10-15 

1 

F.-M. 

Montclair,  N.  J 

1910 

15 

8 

Subnormal 

Morristown,  N.J 

1913 

15 

1 

Mentally  defective 

Muskegon,  Mich 

15 

Classes  for  F.-M. 

New  Brunswick,  N.  J... 

1911 

15 

2 

Mentally  defective 

N.Bergen,  N.Y 

1913 

15 

1 

F.-M. 

Ottumwa,  la 

1913 

13-15 

1 

Subnormal 

Pawtucket,  R.I 

20 

1 

Seriously  backward 
For  those   '3  years    or  more 
below  grade' 

Plainfield,  N.J 

15 

3 

Princeton,  N.  J 

1913 

15 

2 

Mentally  deficient 

Raleigh,  N.  C 

1913 

28 

1 

Subnormal,    seriously    back- 
ward 

Somerville,  N.  J 

1913 

15 

1 

F.-M.  and  seriously  backward 

Stonington,  Conn 

1912 

24 

2 

F.-M,   included  in    ungraded 
class 

Summit,  N.J 

15 

2 

Mentally  defective 

For  older  'boys  2  years  over 

Washington,  Pa 

1913 

18 

1 

, 

age  and  truants' 

TABLE   III — Character  of  Examinatio 

Cities  of  500,000  and  over 


City 

c 

0 

'5  0 

rt    O 

°  a 

a  " 

Character  of 
Examination 

Official  Conducting 
Examination 

Med. 

Psy. 

Ed. 

Ed. 

Psy. 

Baltimore 

Yes 

Yes 

Yes 
Yes 
Yes 

Yes 

Yes 

Yes 

Yes 
Yes 
Yes 

Yes 

Yes 
Yes 

Yes 

Yes 

Yes 
Yes 
Yes 

Yes 

Yes 
Yes 

Yes 

Yes 

Yes 
Yes 
Yes 

Yes 

Boston 

Clinic 

Chicago 

CI. 

Cleveland 

dept. 

New  York 

Psy.  City  College, 
Insp.  of  Un.  CI. 

tch. 

M.D.'s,    psy.,    grs' 
students,  insp.  of 
Un.  CI. 

Philadelphia 

Pittsburgh 

5  M.D.  assts.,    10 
dist.  supts. 

St.  Louis 

Yes 

Yes 

Supt.  of  Spec.  CI. 
Clin,  psy.,  Sept.,  1914 

Clin,  psy.,  beginnii 
Sept.,  1914 

Cities  of  250,000  and  less  than  500,000 


Buffalo .... 
Cincinnati 


Detroit. 


Jersey  City 

Los  Angeles... 

Milwaukee 

Minneapolis 

Newark 

New  Orleans.. . 
San  Francisco. 

Washington  . . . 


Yes 
Yes 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
No^ 
Yes 

Yes 


Yes 
Yes 


Yes 


Yes 


Yes 
Yes 
Yes 
Yes 
Yes 

Yes 


Yes 
Yes 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 


Yes 

Yes 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Supv.  of  Spec.  CI. 


Supt.  of  Spec.  CI. 
Clin.  psy. 
Tch. 
Spec.  tch. 


Med.  Insp.,  Binet 

testers 

Psy.  of  U.  of  Cin 

Supv.  of  Spec.  CI. 


Consulting  psyclj 
spec,  tch.,  Spec.  Mev! 
Insp.  and  M.D.'s 


Supt.  of  Spec.  CI., 
Med.  Insp. 
Clin.  psy. 

Psy. 

Spec.  tch. 

Spec.  tch. 

Director  of  Dept. 
Ed.  Research 
Spec.  tch. 

Binet  tester,  clin. 
psy. 


Given  the  Feeble-Minded  and  Backward 

Cities  of  500,000  and  over 


Agencies  Conducting 
Psy.  Examinations 

Extent  of 

Preparation  of 

Sch.  Psy. 

Examiners 

Extent  of  Psy. 
Examinations 

Child  Study  Laboratory 

or 

Psychological  Clinic 

Med. 
Div. 

Ed. 
Div. 

Outside 
Agency 

Year 
started 

In  what 
dept. 

Approx- 
imate 
cost 

Phipps  Clinic, 
Johns  Hopkins 

State  Psycho- 
pathic Hospital, 
Harvard  U. 

Phipps    Director,    a 
leading    psychiatric 
authority 

Binet  and  other  lab. 
tests 

None 

None 

1898 
None 

1908 

1912^ 

Yes 

2  clin.  psys.,  Ph.D.'s 
and  1  asst. 
Courses   on    mental 
tests  and  subn.  ch. 
'Adequate' 

Med.    Director,    has 
specialized  on  subn. 
ch. 

Clin.  psy. 

Clin,  psy.,  Ph.D. 

Various   psy.    and 
anth.  tests 
Binet  tests 

Not  confined  to  one 
set  of  tests,  test  de- 
pends upon  the  type 
of  child 

Binet  and  other 
psy. tests 

De  Sanctis,  Binet, 
Healy,  Wallin,  anth. 
and  other  tests 
De  Sanctis.  Binet, 
Healy,  Wallin,  anth., 
ed.,    social,    heredi- 
tary, etc. 

Ed. 

$15,000' 

Yes 

Yes 

Yes 

City  College 

For  12  years  co- 
operation  from 
the  psy.  clin.,  U. 
of  Penn. 
Psy.  clinic,  Sch. 
of  Ed.,  U.  of 
Pittsburgh 


Ed. 
Ed. 

$900 
Nominal 

Yes 

1914, 
Sept. 

Ed. 

$450 
Initial 

Cities  of  250,000  and  less  than  500,000 


Yes 

M.D.  Observation  at 
clinics 

Director     Ph.D.    in 
psy.,  2  assts.  trg.  in 
mental   tests    and 
subn. ch. 

One  cUn.  psy.,  M.D., 
and  spec,  tch.,  cours- 
es in  subn.  ch. 

Normal  and  coll. 
grad.,  univ.  trg. 
Psy.,   M.A.,   exten- 
sive experience 

Binet  tests 

Binet,   anth.,   and 
other  tests 

Binet,    form    board, 
educational  tests 

Binet  test  principal- 
ly 
Binet,  others 

1913 
1911 

1914 

None 

1913 

1912 

None 

None 

1912 

None 

1913' 

B.  of  H. 

U.  of 
Cinn. 

$438 
$250 

Yes 

In  B. 

of  H. 

Yes 

Yes 

Yes 
Yes 

Dept.  of  psy.,  U. 
of  Cinn. 

Psy.,    Dept.    of 
Ed.,  U.  of  Mich., 
appointed   con- 
sulting psy., 
Feb.,  1914 

Yes 

Ed. 

Med. 
Insp. 

$750 

Yes 
Yes 
Yes 
Yes 

Yes 

Dept.  of  psy.,  U. 
of  Minni 

Spec.  trg. 

Binet  tests 

Binet,  anth.,  heredi- 
ty 

Healy,    Binet,   form 
board,  anth. 

U.S.  Hospital  for 
Insane 

Ph.D.  in  psy. 

Trg.  in  schs.  for  pre- 
paring tchs.  for  de- 
fectives 

Spec.  trg.  on  defect- 
ives in  summer  schs. 
and  univs. 

Ed. 

$3,500* 

Binet.   form    board, 
audiometer,  spirom- 
eter and  other  lab. 
tests 

Ed. 

$200 

Cities  of  100,000  and  less  than  250,000 


City 


Character  of 
Examination 


Med.        Psy. 


Ed. 


Official  Conducting 
Examination 


Ed. 


Psy. 


Albany . 


Birmingham . 
Bridgeport . . . 
Cambridge.. . 


Columbus . 


Dayton  . . . 
Denver  . . . 

Fall  River. 


Grand  Rapids. 

Indianapolis  . . 

Louisville 

Nashville 

New  Haven . . . 

Oakland 

Paterson 

Providence 

Richmond 

Rochester 


Seattle  . . 

Spokane 
Toledo  . . 


Yes 


Yes 


Yes 


Yes 


Yes 


Yes 


Yes 


Yes 

No^ 

Yes 
Yes 


Yes 
Yes 

Yes 

Yes 


Yes 


Prin.,  Supt.  of  pri- 
mary schs. 


Director  of  Medico 
Psy.  Lab. 


Med.  Insp.,  a  Binet 

tester 

Teh.,  Med.  Insp., 

Prin. 


Yes 

Yes 
Yes 


Yes 
Yes 


Prin. 
Prin.,  tch. 


Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 

Yes 
Yes 


Yes 

No* 
Yes 


Spec,  tch.,  students 
from  State  U. 

Spec.  tch. 

Spec.  tch. 

Spec.  tch.  since  1913 


Supv.  of   backward 
and  f.-m. 


Yes 
Yes 


Spec.  tch. 


Yes 
Yes 
Yes 
Yes 

Yes 

Yes 

Yes 

Yes 


Yes 
Yes 


Yes 
Yes 
Yes 

Yes 

Yes 
Yes 


Yes 

Yes 
Yes 
Yes 
Yes 

Yes 

Yes 


Prin.,  spec.  tch. 
Tch. 

Grade  tch. 
Estimates  by  tch. 

Prin.,  tch. 

Tchs. 


Spec.  tch. 

Clin.  Psy.,  Director 
of  Ch.  Study  Dept. 


Alienist 

Spec.  tch. 

Director  and  Asst. 
Ch.  Study  Dept. 

Head  spec.  tch. 

Spec.  tch. 

Supt.  of  Spec.  Sch. 


Cities  of  25,000  and  less  than  100,000 


Allentown 


Yes         Yes         Yes         Yes      Spec,  tch 


Cities  of  100,000  and  less  than  250,000 


Agencies  Conducting 
Psy.  Examinations 

Extent  of 

Preparation  of 

Sch.  Psy. 

Examiners 

Extent  of  Psy. 
Examinations 

Child  Study  Laboratory 

or 

Psychological  Clinic 

Med. 
Div. 

Ed. 
Div. 

Outside 
Agency 

Year 

started 

In  what 
dept. 

Approx- 
imate 
cost 

Yes 

M.D.,    M.A.,    tch., 
sch.     administrator, 
work  in  f .-m.  institu- 
tions 

De  Sanctis,  Whipple, 
Fernald,  etc. 

Chiefly  Binet 

1913 

Ed. 

$150 

Yes 

Psychopathic 
Hospital,    Dept. 
of  Psy.,  Har\'ard 
Dept.  of  Psy., 
State  U. 

Psys.   and  psychi- 
atrists of  Harvard 

One  tch.  with  spec, 
trg.   on    defectives, 
others  from  books 
Courses    on   mental 
tests  and  subn. 

Binet  and  other  tests 

Binet  (incidentally), 
results  of  book  and 
indv.  trg. 
Binet  tests 

Binet  tests 

Yes 

Yes 
Yes 

Clin,  psy.,  State 
Teh.  College 
since  1911 
Planning  to  work 
under  State  Inst. 
F.-M.,  Waverley 

$1,000 

Yes 

Spec,  courses  in 
mental  tests  and 
subn.  ch. 

Binet  and  other  tests 

1912 

Ed. 

Ind.  U.  during 
1910-11 

Yes 

Summer  courses  on 
subn. ch. 

Binet   and   other 
indv.,  and  phy.  tests 

» 

Clin.  psy.  at  Yale 

Summer  courses  on 

subn.  ch. 

B.A.,  grad.  work   in 

psy. 

Binet  andothertests 
Binet  andothertests 

Yes 

1911 

Ch.  study 
dept. 

$417'° 

B.  of 

Yes 
Yes 

Yes 

Yes 
Yes 

Alienist,    Butler 
Hospital 

M.D..  alienist 

Summer  courses  on 
subn.  ch. 

Summer  courses  on 
subn.  ch.  and  tests 

Clin.  psy.  and   tch. 
with  spec.  trg. 

1911 

B.  of  H. 

H. 

Binet,    assoc.    tests 
and  form  board 
Binet,     De    Sanctis, 
Healy  and    other 
tests. 

1907 
1912 

Ed. 
Ed. 

$500 
$50'' 

Director  of    Ch. 
Welfare  Founda- 
tion, U.  of  Wash. 
Clin,  psy.,  U.  of 
Wash. 

Binet  andothertests 
Binet  tests 

Summer  courses  on 
subn.  ch. 

Cities  of  25,000  and  less  than  100,000 


Yes 


Summer  courses  on  Binet  tests 
subn. ch. 


Cities  of  25,000  and  less  than  100,000  (continued) 


City 

o 

11 
.2  « 

o    o 
a  u 

Character  of 
Examination 

Official  Conducting 
Examination 

Med. 

Psy. 

Ed. 

Ed. 

Psy. 

Yes 
Yes 

Yes 
Yes 

Yes 
Yes 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
No 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 

Yes 

M.D.,  sch.  nurse 

Yes 
Yes 

Chester 

Binet  tester 

Elgin        .                 

Elizabeth 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Yes 

Prin.,  tch. 

Spec.  tch. 

Erie 

M.D.  since  1910 

Ft.  Wayne         

Med.  Insp. 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 

Yes 

Yes 

Yes 
Yes 
Yes 
Yes 

tch. 

Med.  Insp.,  spec,  tc 

Lancaster 

Prin.,  spec.  tch. 

Prin. 

Little  Rock 

M.D. 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 

M.D.  since  1907 

Maiden 

Prin. 

Spec.  tch. 

Supt. 

Prin.,  grade  tch. 

Spec.  tch.  since  1910 

Spec.  tch. 

Spec.  tch. 

Yes 

Yes 

Prin. 

Spec.  tch.  since  19i; 

Cities 

af  25,000  and  less  than  100,000  (continued) 

Agencies  Conducting 
Psy.  Examinations 

Extent  of 

Preparation  of 

Sch.  Psy. 

Examiners 

Extent  of  Psy. 
Examinations 

Child  Study  Laboratory 

or 

Psychological  Clinic 

Med. 
Div. 

Ed. 
Div. 

Outside 
Agency 

Year 

.started 

In  what 
dept. 

Approx- 
imate 
cost 

Yes 

Binet  tests 
Binet  tests 

Yes 

Ed.    dept.,    Cor- 
nell   U.,    during 
1911 

Clin.  psys.  in 
Chicago 

Spec.  tch.  from 
Newark 

Summer  courses  on 
subn. ch. 

Yes 

Summer  courses  on 
subn.  ch. 

Binet  tests 

Psych,  clin.,    U. 
of  Penn. 

Binet  and  other  tests 
Binet  tests 

Yes 

7  years  supv. 

Yes 

Yes 

Spec.  trg.  on  subn. 
ch.  and  tests 

Binet  tests 

Yes 
Yes 

Yes 
Yes 
Yes 
Yes 

Summer  courses  on 

subn. ch. 

Summer  courses  on 

subn.  ch. 

Summer  courses  on 

subn.  ch. 

Summer  courses  on 

subn.  ch. 

M.D. 

Binet  tests 
Binet  tests 

Yes 

Simple  ed.  tests 
Binet  tests 

Yes 

B.   of 

H. 

Yes 
Yes 

Summer  courses  on 
subn.  ch. 

Summer  courses  on 
subn.  ch. 
'Very  limited' 

Binet  tests 
Binet  tests 
Binet  tests 
'No  spec,  tests' 
Binet  tests 

Binet  tester  from 
Vineland,  1913 

Coll.    trg.,    summer 
courses  on  subn.  ch., 
10    yrs.'    experience 
with  subn. 

Yes 

Binet  tests 

Yes 

Summer  courses  on 
subn.  ch. 

Binet  tests 

Cities  of  25,000  and  less  than  100,000  (continued) 


City 


a  .2 


Character  of 
Examination 


Med. 


Psy. 


Ed. 


Official  Conducting 
Examination 


Ed. 


Psy. 


Reading 

Saginaw 

Salt  Lake  City 
Schenectady . . 

Somerville 

Springfield 

Superior 

Tacoma 

Trenton 

W.  Hoboken.. 

Bloomfield 

Englewood  . . . 

Everett    

Goldsboro 

Hackensack  . . 
Hempstead  . . . 

Hibbing 

Hoquiam 

Lakewood 

Leavenworth  . 
Leominster  . . . 
Long  Branch. 
Mason  City... 

Montclair 

Morristown  . . . 


Yes 

Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Yes 

Yes 
Yes 
Yes 


Yes 

Yes 
Yes 
Yes 

Yes 
Yes 


Yes 
Yes 
Yes 

Yes 


Grade  tch. 

Prin.  of  atypical  sch. 


Prin.  and  tch. 


Spec.  tch. 

Spec.  tch.  since  1'  " 
Prin.  of  atypical  sc  ; 
M.D.,  spec.  tch. 

Spec.  tch.  since  1'. 
Director  of  Psy.  L.  i.i 


Yes 
Yes 
Yes 
Yes 


Yes 
Yes 
Yes 


Yes 
Yes 


Prin.  and  tch. 
Prin.,  tch. 
Tch. 


Yes 


Supv.  of  Spec.  Ed 
Spec.  tch.  since  !'•; 


Cities  of  less  than  25,000 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Yes 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Yes 


Yes 
Yes 
Yes 
Yes 
Yes 


Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 
Yes 


Yes 


Yes 


Yes 


Yes 


Yes 


Prin.,  Supt.  1911 


Prin. 


Spec.  tch.  since  1S13 
Spec.  tch. 

Spec.  tch.  since  1911 
M.D.,  spec.  tch. 
Spec.  tch. 


M.D.,  1911,  spec.  t.. 


Med.  Insp. 

Supt. 

Supt.,  spec.  tch. 

Spec.  tch. 

Spec.  tch. 

Spec.  tch.  since  1*^11 

Spec.  tch. 


Cities  of  25,000  and  less  than  100,000  (continued) 


Agencies  Conducting 
Psy.  Examinations 

Extent  of 

Preparation  of 

Sch.  Psy. 

Examiners 

Extent  of  Psy. 
Examinations 

Child  Study  Laboratory 

or 

Psychological  Clinic 

Med. 
Div. 

Ed. 
Div. 

Outside 
Agency 

Year 

started 

In  what 
dept. 

Approx- 
imate 
cost 

Yes 

Yes 
Yes 
Yes 

Yes 
Yes 

Psy.  clin.,  U.  of 
Penn.  for  last  5 
years 

Six  yrs.  contact  with 
subn.  ch. 

Binet  tests 
Binet  tests 

M.A.,  summer  cours- 
es on  subn. ch. 
M.D..  with  spec.  trg. 
in  psy.,  spec.  tch.  trg. 
in  Binet 

Summer  courses  on 
subn.  ch. 
Clin,  psy.,  Ph.D. 

Yes 

Binet  and  other  tests 

Binet  tests 

Anth.,  Healy,  Binet 
and  other  tests 

1912 

Ed. 

$300 

Yes 
Yes 
Yes 

Clin,  psy.,  U.  of 
Wash. 

U.    of    Wash  ,    din. 

psy. 

Clin,  psy.,  Ph.D. 

Summer  courses  on 
subn. ch. 

Binet.  anth.,    social 
and  other  tests 
Binet  tests 

1913 

Ed. 

$200 

Cities  of  less  than  25,000 


Yes 
Yes 
Yes 

Spec,  summer  cours- 
es on  subn. ch. 
Spec.  tch. 

Psy.  in  U.  of  Wash., 
spec.  trg. 

Special   course    in 
summer  schs. 
Summer  courses  on 
subn.  ch. 

Binet  tests 

Binet  tests 

Binet  and  other  tests 

Binet  tests 

Binet  tests 

Clin,  psy.,  U.  of 
Wash. 

Yes 

Yes 

Yes 

Yes 

Yes 

Binet    and   reaction 

tests 

Binet  tests 

Binet  tests 

Binet,  Whipple 

1911'= 

Med.  and 
Ed. 

$500 

Spec.  trg.  in  testing 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

psy.  and  tests 

Binet  tests 
Binet  tests 
Binet  tests 
Binet  tests 

Spec,  summer  course 
on  subn. ch. 
Summer  courses  on 
subn.  ch. 

Spec,  trg.,  state  cer- 
tificate 

Cities  of  less  than  25,000  (continued) 


City 

a 

s  s 

Character  of 
Examination 

Official  Conducting 
Examination 

Med. 

Psy. 

Ed. 

Ed. 

Psy. 

Muskegon  

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
No 

Yes 

Yes 

Yes 
Yes 

Yes 
Yes 
Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 

Yes 

Teh. 

Med.  B.,  Supv.  spec. 

cl. 

Spec,  tch.,  1911 

N.  Bergen 

Ottumwa 

Plainfield  

Princeton 

Raleigh 

Supt.,  spec.  tch. 

Yes 
Yes 

Supt.,  Prin.,  tch. 
Prin. 

Supt.,  Prin..  tch. 
M.D.,  spec.  tch. 
M.D..  spec.  tch. 

Spec.  tch. 

Spec.  tch. 

Summit 

Washington  

M.D.,  spec.  tch. 

^  Annual  budget,  S8,000. 

^  Not  an  organized  department. 

^  Examinations  are  made  after  assignment. 

■*  Total  amount  of  budget  for  Department  of  Research. 

^  The  nucleus  of  a  laboratory  has  been  formed. 

®  Examination  is  given  after  admission. 

'  Equipment  contributed  by  friends. 

^  Except  that  one  or  two  special  teachers  voluntarily  examine  some  pupils. 

*  May  start  a  clinic  in  1914-15. 

'"  Classroom  equipment.  $911. 

"  Also  have  use  of  the  equipment  of  the  University  of  Washington. 

'^  In  modified  form. 


Cities  of  less  than  25,000  (continued) 


Agencies  Conducting 
Psy.  Examinations 

Extent  of 

Preparation  of 

Sch.  Psy. 

Examiners 

Extent  of  Psy. 
Examinations 

Child  Study  Laboratory 

or 

Psychological  Clinic 

Med. 
Div. 

Ed. 
Div. 

Outside 
Agency 

Year 
started 

In  what 
dept. 

Approx- 
imate 
cost 

Yes 

Yes 
Yes 
Yes 
Yes 
Yes 
Yes 

Yes 
Yes 
Yes 

Summer  courses  on 

subn.  ch. 

Summer  courses  on 

subn.  ch. 

Both    have   special 

courses  on  subn.  ch. 

Binet,   anth.,   and 
other  tests 
Binet  tests 

Binet  tests 

Both,   summer 
courses  on  subn.  ch. 
Teh.    spec.    trg.    in 
psy. 

Summer  courses  on 

subn. ch. 

Summer  courses  on 

subn.  ch. 

Both,   spec.  trg.  on 

subn.  ch. 

Binet  tests 

Ed.  and  Binet  tests 

Binet  tests 
Binet  tests 
Binet  tests 

Dept.  of  Psy., 
Princeton  Univ., 
1913 

Abbreviations : 

Anth.=anthropometric.        Assoc.=association.        Asst.=^Assistant. 

Back.=backward.        B.  of.  H.=Board  of  Health. 

CUn.  Psy.=clinical  psychologist.        Cl.=class  or  classes.        Ch.=children. 

Dept.=department. 

Ed.=educational.        F.-M. ^feeble-minded.        Grad. ^graduate. 

Indv.=individual.        Lab.=laboratory.        Med.  Insp.^medical  inspector. 

Psy.=^psychologist  or  psychological.        Prin.=principal. 

Spec.  trg.:=special  training.        Supv.=supervisor.        Spec.=:special.        Sch.=school. 

Subn. ^subnormal.        Spec.  tch.=special  teacher. 

Un. ^ungraded. 


TABLE  IV 

Annual  Salary  Increase  for  Teachers  of  Special  Classes 

FOR    THE    FeEBLE-MiNDED    AND    BACKWARD 


Cities  giving  an  increase  of  $2^0  or  more: 

Muskegon    (start   at  $300   above   regidar  scale) ;   Buffalo,   Harris- 
burg  ($250);  Los  Angeles  ($240). 
Cities  giving  an  increase  of  $200  to  $150: 

Bayonne,  Detroit,  Elizabeth,  Lakewood,  Louisville,  Montclair,  New 
Haven,   Richmond    ($200);   North   Bergen    ($160);   New   Brunswick, 
Paterson,  Superior  ($150). 
Cities  giving  an  increase  of  -flOO: 

Boston,  Bloomfield,  Bridgeport,  Cambridge,  Columbus,  Cincinnati, 
Everett,  Grand  Rapids,  Hackensack,  Hempstead,  Houston,  Lynn 
(expect  to  give  $100  increase),  Milwaukee,  Minneapolis,  Morristown, 
Mt.  Vernon,  Newark,  New  Britain,  New  York,  Philadelphia,  Plain- 
field,  Portland,  Providence,  Raleigh,  Reading,  Saginaw,  Schenectady, 
Somerville,  Spokane,  St.  Louis,  Trenton. 
Cities  giving  an  increase  of  $75  to  $50: 

Somerville,   Mass.    ($75) ;  Jersey  City    ($60) ;   Auburn,   Baltimore, 
Brockton,  Chester,  Chicago,  Dayton,  Denver,  Fall  River,  Little  Rock, 
Memphis,  Passaic,  Rochester,  Worcester  ($50). 
Cities  giving  an  increase  of  50  to  SO  fer  cent  over  regular  scale: 

Allentown  (50  per  cent  increase) ;  Lancaster  (some  get  50  per  cent 
increase)  ;  Goldsboro  (33.3  per  cent  increase) ;  Newton  (head  teacher 
gets  33.3  per  cent  increase  over  highest  paid  teacher). 
Cities   stating   the   amount   of   salary   given   or   giving   an   indefinite 
increase : 

Birmingham  ($100  per  month) ;  Elgin  (not  settled) ;  Englewood 
(slight  increase) ;  Hibbing  (about  $500) ;  Pawtucket  (same  as 
grammar  maximum) ;  Princeton  ($1,000  per  year) ;  Summit  ($900 
to  $1,000  per  year) ;  Niagara  Falls  ($75  per  month) ;  Indianapolis 
(slight  increase  over  maximum  grade  salary) ;  Mason  City  ($10 
more  than  regular  scale) ;  New  Orleans  (tendency  to  increase) ; 
Springfield  (amount  varies)  ;  Washington,  D.  C.  (one  grade  higher 
than  regular  teacher). 

Cities  granting  no  salary  increase: 

Albany,    Cleveland,    Maiden,    Oakland,    Ottiunwa,    Perth    Amboy, 
Seattle,  Tacoma. 
Cities  giving  no  reply: 

Aurora,  Camden,  Decatur,  Hoquiam,  Kalamazoo,  Leominster,  Nash- 
ville, New  Rochelle,  Salt  Lake  City,  San  Francisco,  Stonington, 
Waltham,  Washington,  Pa. 


TABLE  V 
Qualifications   of    Teachers   of   Backward   and    Feeble- 
minded Classes 


Cities  not  appointing  teachers  without  special  preparation: 

Albany  (plan  to  send  teachers  for  special  training — one  teacher  has 
had  training),  AUentown,  Altoona  (will  place  a  trained  teacher  when 
class  is  started),  Auburn,  Baltimore,  Boston,  Bloomfield,  Birmingham, 
Bridgeport,  Buffalo,  Cambridge,  Chester,  Cincinnati,  Dayton,  Denver, 
Detroit  (expect  teachers  to  take  training  after  appointment),  Elgin, 
Elizabeth,  Englewood,  Everett,  Fall  River,  Goldsboro,  Grand  Rapids, 
Hackensack,  Harrisburg,  Hempstead  (try  to  get  especially  trained 
teacher),  Hibbing,  Hoquiam,  Houston,  Indianapolis  (both  teachers 
have  special  training),  Jersey  City,  Kalamazoo,  Lakewood,  Long 
Branch,  Los  Angeles,  Louisville,  Lynn,  Mason  City,  Minneapolis, 
Montclair,  Morristown  (special  teacher  has  had  training  and  two 
years  of  experience),  Newark,  New  Brunswick,  New  Haven,  New 
York,  North  Bergen,  Niagara  Falls,  Oakland,  Passaic,  Paterson, 
Perth  Amboy,  Plainfield,  Portland,  Princeton,  Providence,  Raleigh, 
Rochester  (teachers  who  are  adapted  and  show  special  ability  to  take 
training),  Saginaw  (appointed  with  the  understanding  that  they  are 
to  get  training),  Schenectady,  Seattle,  Somerville,  Mass.  (teachers  are 
to  take  special  training  after  appointment),  Somerville,  N.  J., 
Spokane,  Springfield,  Summit,  Superior,  Tacoma,  Toledo,  Trenton, 
"Washington,  D.  C,  Washington,  Pa.,  West  Hoboken. 

Cities  appointing  teachers  without  special  preparation: 

Bayonne,  Brockton,  Chicago,  Erie,  Maiden,  Milwaukee,  New  Britain, 
New  Orleans,  Newton,  Oakland,  Ottumwa,  Philadelphia,  Reading, 
Rochester,  Stonington,  Worcester. 

Cities  appointing  teachers  for  other  reasons: 

Columbus  (select  teachers  who  are  optimistic  and  skilled  in  indus- 
trial work),  Lancaster  (have  thus  far  selected  teachers  because  of 
apparent  adaptability),  Solvay  (teachers  appointed  who  are  espe- 
cially qualified  for  this  work),  St.  Louis  (appoint  teachers  with 
inclination  and  adaptability). 

Cities  giving  no  reply: 

Aurora,  Decatur,  Leominster,  Mt.  Vernon,  Muskegon,  Nashville, 
New  RocheUe,  Pawtucket,  San  Francisco,  Waltham. 


TABLE  VI 

Ungraded  Classes 


Cities  of  500,000  and  over 


City 

Year 
Started 

05 

Li 

Character  of  Class 

Increase  of 

Salary 
per  Year 

Many  backward  classes 

'Ungraded  classes  for  retard- 
ed pupils' 

No  report 

Ungraded 

18,746  pupils  in  E  classes  for 
backward  pupils  capable  of 
rapid  restoration 

No  classification  as  'ungraded' 

60  tchs.  coach  individuals  in 
small  groups 

4  schools  for  'children  who 
cannot  best  be  cared  for  in 
regular  grade  schools' 

$50 

80 

$50 

Cleveland,  O 

10-20 

10 

New  York,  N.  Y 

Philadelphia,  Pa 

Pittsburgh,  Pa.. 

60 

$100 

Cities  of  250,000  and  less  than  500,000 


Buffalo,  N.  Y 

A  large  number  of  classes  for 

'pupils  without  mental  de- 

fect, but  retarded' 

Cincinnati,  O 

1910 

25 

S 

'Retarded,  all  types' 

$50 

Los  Angeles,  Cal 

1902 

20-24 

75 

Ungraded 

$240 

Milwaukee,  Wis 

1912 

15 

30 

Over  age,  but   not  mentally 
defective 

$100 

Newark,  N.  J 

1913 

25-30 

2 

Retarded 

$100 

1910 

half-time  kindergartners  in 

afternoons 

■Washington,  D.  C... 

1905-6 

16 

1 

Ungraded.    Class  'not  now  in 

operation' 

Cities  of  100,000  and  less  than  250,000 


Albany,  N.Y 

Birmingham,  Ala. 
Bridgeport,  Conn. 
Cambridge,   Mass. 

Dayton,  O 


Denver,  Col 

Fall  River,  Mass 

Grand  Rapids,  Mich. 
Indianapolis,  Ind. . . . 
Kansas  City,  Mo.... 


Louisville,  Ky. 
Lowell,  Mass.. 


Memphis,  Tenn. 


1911-12 


1911 
1913 

1910 
1909 
1908 


1913 
1912 


46 

25 

2 

20-25 

1 

20 

20 

15-18 

2 

5-20 

8 

20-25 

21 

10 

1 

15-18 

s 

One  ungraded  school 

Ungraded 

Backward 

'Principal  looks  after  pupils 
retarded' 

One  school,  vocational  sum- 
mer classes,  continuation 
classes 

Ungraded 

Retarded  and  ungraded 

Ungraded 

Backward 

For  pupils  failing  to  do  regular 
work,  also  8  industrial  class- 
es, since  1910 

Retarded 

15  to  20  substitute  teachers 
work  with  the  backward 

Over  age,  exceptionally  dull, 
bright 


Cities  of  100,000  and  less  than  250,000   (continued) 


City 

Year 
Started 

o-Sl 

Character  of  Class 

Increase  of 

Salary 
per  Year 

Oakland,  Cal 

1912 

1907 
1912 

25 

20 
25 
8-12 
25 
20-24 
23 

No 
limit 

25' 

15-20 

3 

5 

2 

"3' 
4 
2 

40 

2 

Ungraded,  started  a  long  time 
ago,  abandoned,  opened 
again  in  1912 

Ungraded 

Ungraded 

Ungraded 

Ungraded 

Retarded 

Ungraded,  'each  school  gives 
special  help  to  backward  ch . ' 

'Ungraded  rooms  for  back- 
ward' 

Ungraded 

Ungraded 

One  school  for  the  over  age 
and  backward 

One  school  for  boys  retarded 
2  or  more  years 

Ungraded 

Portland,  Ore 

Providence,  R.I 

Richmond,  Va 

Rochester,  N.  Y 

St.  Paul,  Minn 

1896 
1913 
1910 

1906 

1912 
1907 

$50 

SlOO-200 

$50 

Seattle,  Wash 

Toledo,  O 

24 

6 

$50 

Cities  of  25,000  and  less  than  100,000 


Camden,  N.  J 

Charleston,  S.  C... 
Chattanooga,  Tenn. 
Elgin,  lU 


Elizabeth,  N.  J.. 
Fitchburg,  Mass. 
Holyoke,  Mass.. 


Huntington,  W.  Va. 


Jackson,  Mich.. 
Johnstown,  Pa. 
Lancaster,  Pa.. 


Lynn,  Mass 

Manchester,  N.  H. 


New  Britain,  Conn. 

Newport,  R.I 

New  Rochelle,  N.  Y. 


Newton,  Mass.. . 
Pasadena,  Cal. . . 
Portsmouth,  Va. 


Poughkeepsie,  N.Y. 
Roanoke,  Va 


Salem,  Mass 

San  Antonio,  Tex. 


San  Diego,  Cal 

Salt  Lake  City,  U... 

Schenectady,   N.  Y. 
Sioux  City,  la 


1913 
'i9U 


1911 
"i9i2' 

1911 

1913 


1906 
1907-8 


1912 
1912 


30 

12-18 

14 


20 

20-25 

25 


10-20 


15-20 
15-20 


15 
15-70 


20 
4-9 


'Excessive  age  and  doubtful 

mentality' 
LTngraded 
Ungraded 
Ungraded  for  those  retarded 

in  various  subjects 
For  boys  mentally  very  slow 
Ungraded,  'coaching' 
Ungraded 

1  teacher  in  each  large  build- 
ing coaches  the  retarded 

Ungraded 

Ungraded 

Sometimes  admit  35  on  ac- 
count of  crowding.  Back- 
ward and  precocious 

Backward 

'Substitute  teachers  help 
backward  pupils' 

Backward  or  over  age 

Two  'unassigned  teachers' 

Ungraded  classes  for  giving 
indiv.  attention 

Ungraded 

'Special  study  rooms' 

'Dull'  in  certain  divisions  of 
classes 

Ungraded  class 

'Divisions  of  fast,  medium, 
slow' 

Ungraded 

'Teachers  take  charge  of 
rooms'  for  backward  chil- 
dren 

Ungraded 

Ungraded  rooms  for  bright 
and  slow 

Ungraded 

Two  teachers  give  individual 
attention  in  5  schools 


$50 


Increase 
expected 


$100 


None 


None 


Cities  of  25,000  and  less  than  100,000  (continued) 


City 

Year 
Started 

in 

<M  1) 

0   <A 

:2;u 

Character  of  Class 

Increase  of 

Salary 
per  Year 

1910 

25 

22 

15-20 

25 

5-12 
Varies 

1 
.... 

9 

4 
3 
2 
4 

1 

South  Bend,  Ind 

Ungraded  rooms 

Ungraded 

Backward  and  non-English- 
speaking.  Also  2  practical 
arts  classes,  since  1913 

Special  aid 

Ungraded 

'Dull' 

Teachers  handle  as  many  as 
possible  in  ungraded  rooms 
for  retarded 

Ungraded,  'atypical' 

1150 

S.  Orange,  N.  J 

1894 
1911 

Superior,  Wis 

Tacoma,  Wash 

$60 

Trenton,  N.  J 

1905 
1913 

1912-13 

Waco,  Tex 

Cities  less  than  25,000 


Albuquerque,  N.  M. 
Appleton,  Wis 


Beverly,  Mass.. . 
Bismarck,  N.  D. 


Champaign,  111. 
Concord,  Mass. 


Claremont,  N.  H. 
Denison,  Tex 


Eveleth,  Minn.. 
Everett,  Wash. 


Goldsboro,  N.  C... 
Great  Falls,  Mont. 


Hibbing,  Minn. 
Hillsboro,  Tex. . 


Ironwood,  Mich 

Kenosha,  Wis 

Lead,  S.  D 

Long  Branch,  N.  J. 
Ludington,  Mich 


Ma.son  Citv.  la 

Munhall,  Pa 

New  London,  Conn. 


Paris  City,  111. 


Parkersburg,  W.  Va. 
Rockland,  Me 


Rockland,  Mass 

Southington,  Conn. 
Stonington,  Conn... 


Summit,  N.  J.. . 
Uniontown,  Pa. 


1911 


1909 
1911 


1913 


1913-14 

1912 

1911-12 

1913 

1912 


1913 
1912 


1912 
"\9\2 


10-15 

20 

3-8 


16 

20-25 

24 


Ungraded 

Unlimited  number  handled  in 
ungraded  classes 

Teachers  coach  backward 

Ungraded  class  abandoned 
because  of  lack  of  room 

Substitute  teachers  instruct 
small  classes 

Retarded  grouped  in  various 
classes 

Ungraded 

'Industrial  instruction  to  re- 
tarded' 

Ungraded 

Retarded,  conducted  in 
groups  of  from  1  to  6  pupils 

Backward 

Individual  help  before  and 
after  school 

Rooms  for  'backward  and 
hand-minded' 

'Misfits,  retarded  in  one  or 
more  subjects' 

Backward  and  truant 

Ungraded 

Ungraded 

Ungraded 

Individual  attention  to  excep- 
tional children 

Ungraded 

Ungraded 

One  teacher  coaches  back- 
ward 

'2  divisions  in  each  grade  to 
give  special  attention  to  re- 
tarded' 

'Special  help'  in  1  or  2  class- 
es in  each  building 

'Backward  of  7th  and  8th 
grades' 

Summer  classes  for 'repeaters' 

'Opportunity  classes' 

'Special  classes  for  1st  three 
grades' 

Retarded 

'Ungraded  classes  in  1st  to 
4th  grades' 


Cities  of  less  than  25,000  (continued) 


City 


Year 
Started 


■  no 

O  3 


6S 


Character  of  Class 


Increase  of 

Salary 
per  Year 


Winchester,  Ky 

Winchester,  Mass... 

Winona,  Minn 

Winsted,  Conn 


1901 
1913 


1912 
1911 


1-4 
12 


'Modification  of  Batavia  plan' 

in  every  grade 
'Pupils  unable  to  do  regular 

work' 
Ungraded 
Ungraded 


TABLE  VII 

Classes  for  Epileptics 


City 

Year 
Started 

Character  of  Class 

Baltimore,   Md 

Chicago,  111 

Cleveland,  O 

1912 
1914 

1  class 

3  classes  in  process  of  organization 

Reading,  Pa 

1908 

Included  in  class  for  defectives 

TABLE  VIII 
Classes  for  Disciplinary  and  Truant 


Cities  of  500,000  and  over 


City 

Year 

Started 

0  « 

Character  of  Class 

Chicago,  111 

Cleveland,  O 

1908 
1902 

25 

12 

2 
15 

1 

Industrial  truant  school 

250  pupils  in  one  parental  sch.  for  truants 

New  York,  N.  Y 

Pittsburgh,  Pa 

About 

1874 
1913 

33 

Disciplinary  or  truant 

In  detention  rooms  of  Juvenile  Court 

ent  and  delinquent 

Cities  of  250,000  and  less  than  500,000 


Buffalo,  N.  Y 



25 
15 

"s' 

Los  Angeles,  Cal 

1904 
1899 

Incorrigible 

Cities  of  250,000  and  less  than  500,000  (continued) 


City 

Year 
Started 

m 
o  3  „ 

O  0) 

:2;u 

Character  of  Class 

Newark,  N.  J 

1898 

20 

5  classes  each  in  3  schs.    Ungraded,  dis- 
ciplinary and  truant  _ 

Washington,  D.C... 

1906 

16-25 

dren's  Harbor  and  Reform  Sch.' 
One  sch.  for  disciplinary  and  truant 

Cities  of  100,000  and  less  than  250,000 


Brockton,  Mass 

Dayton,  O 

Denver,  Col 

Grand  Rapids,  Mich. 
Indianapolis,  Ind. . . . 

Kansas  City,  Mo 

Louisville,  Ky 


New  Haven,    Conn. 

Oakland,  Cal 

Omaha,   Neb 

Paterson,  N.  J 

Portland,  Ore 

Providence,  R.I 

Rochester,  N.  Y 

St.  Paul,  Minn 

Seattle,  Wash 

Spokane,  Wash 


Syracuse,  N.  Y. 


1910 
1911 
1910 


1910 


1910 
1913 
1912 


1896 
1899 
1911-12 
1906 
1909 
1913 


25 


For  boys 

One  sch.  for  truants  and  troublesome  ch. 

DiscipHnary 

One  truant  sch. 

100  ch.  in  one  truant  sch. 

200  ch.  in  the  'home  of  juvenile  court' 

'Ch.    giving    trouble    in    discipline    and 

attendance' 
Truant  and  incorrigible 
DiscipHnary 

'A  special  school  for  boys' 
Incorrigible 

Classes  for  disciplinary  and  truant 
Disciplinary 
Truant,  2  teachers 
Two  parental  and  detention  schs. 
100  ch.  from  all  grades 
One  parental  sch. 
CI.  for  incorrigibles 
Disciplinary  and  truant 


Cities  of  35,000  and  less  than  100,000 


Bayonne,  N.  J.. 
Camden,  N.  J.  . 
Decatur,  111.  . . . 
Elizabeth,  N.  J. 


Harrisburg,  Pa.  . . 
Kalamazoo,  Mich. 

Pueblo,  Col 

Reading,  Pa 

St.  Joseph,  Mo 

Tacoma,  Wash 

Trenton,  N.  J 

Waltham,  Mass... 


1909 
1912 
1912 
1912 

1902 


1911 
1908 


1905 


Incorrigible 

Troublesome  boys 

Included  in  ungraded  school 

'For  the  obscene  in  manner,  speech  and 

action' 
Incorrigible  and  truant 
Classes 

One  sch.  for  boys 
Truant  and  incorrigible 
One  sch.  for  truants 
Parental  sch.  for  boys 
Disciplinary  and  truant 
Sent  to  'County  Training  School' 


Cities  of  less  than  25,000 


Bloomfield,  N.  .1. 
Ironwood,  Mich. 
Montclair,  N.  J.. 
Morristown,  Pa. 
Plainfield,  N.  J.. 
Princeton,  N.  J.. 
Washington,  Pa. 


1912 
1910 
1913 
1909 
1913 
1913 


Practically  incorrigible 

Included  among  the  ungraded 

Incorrigible 

Incorrigible 

For  unruly  boys 

Included  in  speech  defective  els. 

Incorrigible 


TABLE  IX 

Classes  for  Foreigners 


City 

Year 
Started 

Character  of  Class 

Bayonne,  N.J 

1912 

1  class  for  foreign-bom 
Non-English-speaking 

Bridgeport,  Conn 

1910 

2  classes 

1  class  for  non-English-speaking 

Cleveland,  O    

4  classes  for  children  'just  over' 

Denver,  Col 

Fall  River,  Mass 

Hackensack,  N.J 

Hibbing,  Minn 

Lynn,  Mass 

Manchester,  N.  H 

1911 
1913 

1912 
1913 
1908 
1910 

1  class 

15  classes  of  children  ranging  from  10  to 

15  years  of  age 
Class  for  foreigners 
1  room  for  non-English-speaking 
4  classes 
Classes  for  non-English-speaking 

New  York,  N.  Y 

1,474  pupils  in  C  classes 

Philadelphia,  Pa 

Pittsburgh,  Pa 

Rochester,  N.  Y 

1913 
1912 
1S99 

2  classes  for  foreigners 

2  evening  classes  for  adult  foreigners 

12  classes 

speak  English 

1910 

Included  in  ungraded  class 

1894 

classes 
2  classes  for  foreigners 

Trenton,  N.  J 

Washington,  D.  C 

1905 

1  class  for  non-English-speaking 
Day  (1)  and  night  (12)  classes 

Winsted,  Conn 

Italians  placed  in  backward  classes 

TABLE  X 

Classes  for  the  Deaf 


City 

Year 

Started 

Character  of  Class 

Appleton,  Wis. 

Atlanta,   Ga 

Cleveland,  O.                         

1913 
1912 

Deaf  included  among  speech  defectives 
1  class 

Chicago,  111 

Dayton,  O 

Decatur,   111 

1895 
1911 
1912 

3  schools 

1  special  school 

Included  in  ungraded  class 

Grand  Rapids,  Mich 

Jersey  City,  N.  J 

Kenosha,  Wis 

Lancaster,  Pa 

Los  Angeles,  Cal 

Milwaukee,  Wis 

Newark,  N.J 

New  York,  N.  Y 

Oakland,  Cal 

Portland,  Ore 

1910 
1911 
1913 
1913 
1900 
1876 
1910 
1909 
1901 

1  school 

1  class 

Deaf  included  among  speech  defectives 

1  school 

4  classes 

17  classes 

6  classes 

30  classes,  9  pupils  to  each  class 

1  class 

Reading,  Pa 

1908 

Deaf  placed  in  defective  class 

Classes  for  the  Deaf  (continued) 


City 

Year 
Started 

Character  of  Class 

Rock  Island,  111 

San  Diego,  Cal 

Saginaw,  Mich 

Seattle,  Wash 

1903 
1912 
1907 
1911 

1  class,  limited  to  10  pupils 
1  class 
1  class 
3  classes 

St.  Paul,  Minn 

Tacoma,  Wash 

Toledo,  O 

1913 
1909 

1  school 
1  class 

TABLE  XI 

Classes  for  the  Blind 


City 

Year 
Started 

Character  of  Class 

Chicago,  111 

1899 

Cleveland,  O 

Milwaukee,  Wis 

Newark,  N.  J 

New  York,  N.  Y 

New  York,  N.  Y 

Reading,  Pa 

1908 
1910 
1907 
1912 

1908 

3  classes 

1  class 

15  classes,  9  in  each  class 

'Inflammatory  eye  diseases,'  2  classes,  30 

pupils 
Blind  placed  in  defective  class 

TABLE  XII 

Classes  for  Speech  Defects 


City 

Year 
Started 

Character  of  Class 

Appleton,  Wis 

1896 
1912 

For  the  deaf  and  speech  defective 

Aurora,  111 

Placed  in  the  feeble-minded  class 

Chicago,  111 

Visiting  teachers  cover  ^  of  city  twice 

Decatur,    111 

Detroit,   Mich 

1912 

each  week 
Placed  in  ungraded  class 
Classes 

Houston,  Tex 

Jersey  City,  N.  J 

1908 
1911 

Placed  in  feeble-minded  classes 

1  class 

Kenosha,  Wis 

Milwaukee,  Wis 

1913 
1912 
1912 

Stutterers  placed  in  deaf  classes 

12  classes 

Classes  for  Speech  Defects  (continued) 


City 

Year 
Started 

Character  of  Class 

New  York,  N.  Y 

Pittsburgh,  Pa 

Princeton,  N.J 

Rochester,  N.  Y 

Rock  Island,  111 

1911 
1912 

1913 

1913 

6  classes 

4  visiting  teachers  work  in  different  sec- 
tions of  city 

'Mentally  deficient  through  speech  de- 
fect' 

1  class 

1  class 

St.  Paul,  Minn 

1913 

School  for  speech  and  hearing  defects 

TABLE  XIII 

Classes  for  Bright  Children 


City 

Year 
Started 

Character  of  Class 

3  schools  for  pupils  of  unusual  ability 

Boston,  Mass 

1913 

Rapid  advancement  classes 

Harrisburg,  Pa 

1902 

1  class  for  bright  pupils 

Lancaster,  Pa 

Long  Branch,  N.  J 

Louisville,  Ky 

1912 
1912 
1910 

Included  in  ungraded  class 

Rapid  moving  classes 

Special  classes  for  the  accelerated 

Montclair,  N.J 

1910 

1  class  for  gifted  children 

Pasadena.  Cal 

1907-8 

Special  study  rooms 

Salt  Lake  Citv,  U 

Springfield,   Mass 

Solvay,  N.  Y 

1912 

Extra  study  groups 

Waco,  Tex 

1913 
1913 

Washington,  D.  C 

1  class 

TABLE  XIV 

Orthopedic  Classes 


City 

Year 
Started 

Character  of  Class 

Baltimore,  Md 

Detroit,  Mich 

1912 

3  classes 

Newark,  N.J 

New  York,  N.  Y 

Philadelphia,   Pa 

1913 
1906 
1913 

1  class 

36  classes,  30  pupils  to  each  class 

Orthopedic,  2  classes 

TABLE  XV 

Open  Air  Schools 


City 

Year 

Started 

Character  of  Class 

Buffalo,  N.  Y 

Chicago,  111 

Louisville,  Ky 

Minneapolis,  Minn 

Newark,  N.J 

New  York,  N.  Y 

Pawtucket,  R.I 

1910 
1910 
1911 
1911 
1911 
1910 

2  open  air  schools,  1  in  prospect 

11  classes,  open  air  and  low  temperature 

For  anemic  children 

2  tubercular  classes 

3  tubercular  classes,  1  open  air 
Tubercular,  20  classes,  23  pupils  to  each 

class 
Anemic,  41  classes,  21  pupils  to  each  class 

Philadelphia,  Pa 

Pittsburgh,  Pa 

1911 
1912 
1912 

5  open  window 

1  tubercular 

One  class  for  tubercular  children  (started 
by  Tuberculosis  League  of  Civic  Club 
of  Allegheny  County  in  1907) .  One  class 
for  anemic  children  (started  by  Tuber- 
culosis League  in  1911) 

I  am  indebted  to  Miss  Eva  Webb  for  assistance  in  tabulating 
these  returns,  and  to  my  wife  for  considerable  stenographic  work 
in  connection  with  the  book. 


CHAPTER  XIX 

A    SCHEMA    FOR    THE    CLINICAL    STUDY    OF 

MENTALLY  AND  EDUCATIONALLY 

UNUSUAL  CHILDREN 

The  scientific  study  of  the  educationally  exceptional 
child  should  follow  a  definite  plan  of  procedure  and  should 
be  sufficiently  comprehensive  to  include  an  investigation 
of  all  the  important  intrinsic  and  extrinsic  factors  which 
may  mar  his  development.  A  complete  investigation 
should  include  the  study  of  the  child's  developmental, 
family,  hereditary  and  school  histories,  an  investigation  of 
his  past  and  present  social  and  physical  environment,  and 
an  examination  of  his  present  physical  condition  and 
anthropometric,  educational  and  psychological  status.  A 
completely  satisfying  investigation  thus  requires  the  co- 
operation of  the  social  and  hereditary  worker,  the 
teacher,  the  medical  expert  and  the  psycho-educational 
clinician. 

The  following  schema  is  offered  as  a  guide  to  the  scien- 
tific examination  of  mentally  abnormal  children.  It  may 
be  used  in  either  of  two  ways.  First,  the  various  forms 
may  be  reprinted  on  separate  blanks  with  appropriate 
vacant  spaces,  to  be  filled  in  by  the  investigator.  The 
chief  objection  to  this  plan  is  probably  financial:  blanks 
are  expensive,  and  in  few  cases  will  it  be  possible  to  fill  out 
all  the  spaces,  while  in  many  cases  it  will  not  be  necessary 
to  do  so.  Second,  the  investigator  may  thoroughly 
familiarize  himself  with  the  contents  of  the  various  forms, 


430    MENTAL  HEALTH  OF  SCHOOL  CHILD 

and  follow  them  as  a  systematic  and  comprehensive  guide 
to  his  investigation ;  but  instead  of  entering  the  data  on 
printed  blanks  he  may  write  up  a  'running  history,'  giving 
the  essential  facts  of  the  case,  on  blank  sheets.  Whether 
the  one  plan  or  the  other  is  followed,  it  is  desirable  that 
every  investigator  should  append  a  brief  summary  of  his 
findings  and  recommendations. 

It  cannot  be  too  forcibly  impressed  upon  social,  field 
and  laboratory  investigators  of  children  that  parents  and 
relatives — or  any  from  whom  bio-social  data  are  sought — 
must  be  approached  with  much  tact  and  judgment. 
Gathering  hereditary,  personal  and  social  data  is,  at  best, 
a  very  delicate  undertaking,  subject  to  many  errors,  and 
many  investigators  fail  utterly  to  secure,  or  otherwise 
they  pervert,  the  significant  factors,  either  because  they 
do  not  know  how  to  approach  parents  so  as  to  win  their 
confidence  and  put  them  in  a  communicative  attitude,  or 
because  they  suggest  answers  by  their  indiscreet  use  of 
leading  questions.  While,  therefore,  a  'guide'  will  prove 
of  the  greatest  value  to  child  investigators,  they  must 
know  above  all  else  how  to  use  the  guide  with  tact,  common 
sense  and  discriminating  intelligence. 

Social  and  hereditary  investigators  must  also  be 
cautioned  against  drawing  premature  or  unjustifiable 
conclusions  from  hearsay  evidence.  They  must  accustom 
themselves  to  weigh  reports  very  carefully,  and  to  verify 
them  in  every  way  possible.  There  is  a  large  amount  of 
work  done  today  in  heredo-biology,  heredo-psychology  and 
social  investigation  which  is  careless,  unscientific  and 
worthless.  Do  not  conclude  that  someone  was  feeble- 
minded or  insane  simply  because  someone  reported  him 
to  be  'slow,'  'stupid,'  'feebly-gifted'  or  as  acting  'queerly.' 
Do    not    conclude    that    a    child    is    feeble-minded    simply 


SCHEMA  FOR  CLINICAL  STUDY  431 

because  he  appears  stupid  or  feeble-minded  to  you,  or 
because  he  happens  to  test  three  years,  or  even  four  or  five 
years,  retarded.  Science  cannot  be  founded  on  guess- 
work. Gather  all  possible  facts  bearing  on  your  case, 
and  avoid  hasty  generalizations.  It  is  rather  for  the 
trained  specialist  to  supply  the  diagnoses. 

It  need  scarcely  be  said  that  when  the  same  person 
gathers  the  developmental,  hereditary  and  school  data,  it 
is  not  necessary  to  re-record  on  each  blank  the  identical 
facts  called  for  in  the  different  blanks  unless  there  is  a 
discrepancy  in  the  statements. 

FORM  I 

DEVELOPMENTAL  HISTORY 

Source  of  data  Date 

Age:  date  of  birth 
Address    (with    'phone)  Father's 

Mother's  name  Guardian's 

By  whom  referred  for  investigation 

(Underscore  appropriate  words,  and  fill  in  other  data) 

CoNCEPTivE  Conditions:  diseases,  syphilis,  gonorrhea,  tuberculosis, 
scrofula,  alcohol,  drugs,  health,  overwork,  starvation,  fright,  accidents, 
anxiety,  excitement,  aversion,  etc.,  before  or  at  time  of  conception  in 
mother 
in  father 

Pregnancy  Conditions:  above  data  for  mother  during  pregnancy. 
Also  pelvic  diseases,  attempts  at  abortion,  'maternal  impressions,' 
legitimacy  of  child 

Birth    Conditions:    premature    (how    much)  full   term, 

weight  labor   normal,   prolonged    (how   long)  or 

diflBcult;  delivery  with  instruments  or  anesthesia;  difficult  animation, 
breathing  or  crying,  cyanosis;  injury  or  deformity  (especially  of 
head)  or  paralysis;  inability  to  suckle 

Growth  Conditions:  nursed   (by  whom,  how  long) 
Bottle  fed   (how  long,  what)  What  fed  when 

weaned  Sickly  as  baby  or  child  First 


No. 

Diagnosis 

Full  name 

yrs. 

mos. 

name 

name 

By 

432    MENTAL  HEALTH  OF  SCHOOL  CHILD 

teeth,  when  (any  fever  or  illness)  Second  teeth, 

when  Fontanel,  closed   when  First 

crawled,  when  Stood  alone,  when 

Walked   (unsupported  steps),  when  Walked  well, 

when  Ran  well,  when  Supported  head, 

when  Talked — single   words   correctly   applied, 

when  Short  phrases,  when  Complete 

sentences,  when  Specific  speech  defects,  what, 

since  when,  circumstances  Able  to  hold  or  grasp  well, 

when  Control  of  fundamental  reflexes   (acquisition 

of  tidy  habits),  when  Beginning  of  puberty 

Of  menstruation  (difficult) 

Diseases  and  Accidents  (age,  attributed  cause,  severity,  subsequent 
eflfects,  recovery) :  measles,  smallpox,  whooping  cough,  scarlatina, 
scarlet  fever,  mumps,  diphtheria,  cerebro-spinal  meningitis,  infantile 
paralysis,  rickets,  malnutrition,  inanition,  scrofula,  swollen  glands, 
adenoids,  enlarged  tonsils,  nose,  eyes,  ears,  nervousness,  muscular 
twitches,    where  chorea,    periodical    headaches,    fainting 

spells,  convulsions   (infantile  or  epileptic,  with  data) 
enuresis  (nocturnal  or  diurnal),  falls,  injuries,  orthopedic  deformities, 
pubertal  or  menstrual  troubles  Vaccinated,   when, 

efi'ects  Hospital  or  surgical  record 

M.  D.'s  by  whom  examined  or  treated 
Diagnoses  by  difl'erent  M.  D.'s 

Habits:   sleep    (past  and  present):  hours   of  retiring  and   arising 
sound,   restless,   insomnia    (cause).      Drinking: 
tea,   coffee,  wine,  beer,  whisky;   drugs    (how  much,  how  frequently) 
Appetite:  hearty,  poor,  capricious,  gluttonous,  food 
preferences,  usual  menu  Chews   or  smokes:  cigarettes, 

cigars,  pipe.       Excessive  indulgence  in  sweets  Masturbates, 

sexually  immoral  or  perverse. 

Mental  and  Physical  PECtJLiARiTiES  in  Infancy  and  Childhood 
(age  first  observed,  parents'  explanation) :  queer  or  bizarre  ideas, 
action,  behavior,  speech,   disposition  Fits   of  crying  or 

laughing,  with  or  without  cause  Outbreaks,  tantrums, 

continuous  or  periodic  Night  terrors,  sleep-walking 

Morbid   fears  Criminal,  intemperate,  immoral  or 

destructive  tendencies  Running  away  Solitude 

or  company  preferred  Shut-in,  solitary  disposition 

Playing  or  seeking  younger  or  older  persons  or  opposite  sex 
Dull,    stupid,    lazy,    indifferent,    bright,    talented,    precocious     (with 
facts) 


SCHEMA  FOR  CLINICAL  STUDY  433 

Record    of    DEUNauEKCiES     (with    ascribed    causes,    institutional, 
court  and  probation  records) : 

Agencies  which  have  previously  been  interested  in  this  child: 

Additional  Remarks: 

Recommendations  (by  whom) : 

Results  of  Following  Recommendations  (as  reported  later) : 

Signature  : 

FORM  II 

FAMILY   AND   HEREDITARY   HISTORY 

No.  Diagnosis  Source  of  data  Date 

FuU  name  Bom,  where  Age:  date  of 

birth  yrs.  mos.  Lives  with  at 

(street,  with  'phone)  Name,  with  birthplace,  nationality 

and  religion  of  father  of  mother 

Language  spoken  at  home  Order  of  child's 

birth  no.  of  sisters,  alive  dead  of  brothers, 

alive  dead  Age  of  father  at  child's  birth  of  mother 

Blood   relationship   between   parents  Parents   living 

apart,  together,  divorced.     Occupation  and  weekly  earnings  of  father 

of  mother  of  other  children  of  child 

Health,  morals,  habits,  diseases,  sexual  habits,  etc.,  prior  to  birth  of 
child,  of  father  of  mother  (see  Form  I) 


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SCHEMA  FOR  CLINICAL  STUDY  435 

FORM  III 

HOME  AND  NEIGHBORHOOD  ENVIRONMENT 

No.  Diagnosis  Source  of  data  Date 

FuU  name  Age:  date  of  birth 

yrs.  mos.  Address    (with  'phone)  Lives 

with  Parents'  address,  if  different 

Father's  name  Mother's  name 

Parents  alive  Parents  living  together  If 

separated,  divorced  or  deserted.    Guardian's  name  and  address 

Child's  birthplace  Language  spoken  in 

home  Referred  for  investigation  by 

Successive   places   of   residence    (with   sanitary,   hygienic   and   moral 
conditions  of  each) 

Present  Home  Influences 
(Underscore  appropriate  words,  and  fill  in  other  relevant  data) 

Financial:  rich,  moderate,  poor,  impoverished,  proverty-stricken, 
charity  case.     Weekly  earnings  of  father  mother 

children  Breadwinners,  who  Influence  of  financial 

conditions  on  child's  care 

Food:  quantity  quality  Drinks: 

what  how  often  how  much  No.  of  meals 

(typical  menus) 

Clothing:  ample,  insufficient,  shabby,  soiled,  tasteless,  immodest 
(eflfect  on  child) 

Bathing:  frequency 

Housing:  flat,  tenement,  house;  no.  of  rooms  of  bedrooms 

bathroom  no.  of  lodgers  in  family  of  boarders 

Clean,  bright,  sunshiny,  artistic,  attractive,  dark,  dingy,  damp,  filthy, 
disordered,  well  or  poorly  ventilated.     Garbage  Sewerage 

Child's  bedroom:  quiet,  good  ventilation,  light,  sleeping  companions, 
no.  in  room  Hours  of  retiring  and  arising 

Home  Life:  excellent,  tranquil,  religious,  moral,  refined,  upset,  dis- 
turbed, boisterous,  raw,  quarrelsome,  brutal,  fighting,  vulgar,  degrad- 
ing irreligious,  immoral,  bad. 

Home  Treatment:  excellent,  good,  kindly,  good  care,  indifferent, 
neglectful,  poor  care,  parents  away,  petted,  coddled,  well  or  poorly 
disciplined,  ridiculed,  rebuffed,  irritated,  maltreated,  whipped, 
frightened,  abused,  by  father,  mother,  stepmother,  siblings,  guardians, 
etc.    Overworked 


436    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Child's  Deportment  at  Home:  excellent,  good,  average,  poor,  bad; 
obedient,  disobedient;  mischievous,  quarrelsome,  fights,  cruel  to 
animals  or  siblings  or  plajTnates,  incorrigible,  destructive;  cheats, 
steals,  squanders  money,  pawns,  gambles,  plays  craps,  deceives,  lies, 
untrustworthy;  neat,  careless,  indolent,  immodest,  immoral;  runs 
away.  Attitude  toward  parents,  siblings,  playmates,  strangers 
Toward  reprimands  and  punishment  How  punished 

Deportment  of  siblings  at  home 

Amusements  at  Home:  what,  cards,  games,  plays,  singing,  music, 
reading,  proper,  improper.     How  does  child  spend  leisure  time? 

Chief  interests   at  home  Vacations, 

when  where    spent 

Work:  complete  record  of  jobs,  with  dates,  how  long  held,  hours, 
pay,  success,  reasons  for  changes  or  discharge 
Age  on  taking  first  job 

Religious  Disposition:  religious,  irreligious  or  indifferent.  Attends 
church,  where,  how  often,  willingly  or  reluctantly 
Attends  Sunday  school,  where,  how  often,  willingly 

Neighborhood  Influences 

Physical  Surroundings:  sanitary,  insanitary,  dark,  smoky,  filthy, 
slummy,  densely  populated,  foreign  population,  saloons,  dance  halls, 
gambling  joints,  picture  shows,  immoral  resorts. 

Social  Environment:  character  of  chums  or  associates  (boys,  girls, 
adults),  good,  bad,  vulgar,  gamblers,  crap  players,  immoral,  corrupt, 
criminal,  thieves.  Belongs  to  clubs  or  gangs,  as  leader  or  follower,  what 
kind  (social,  amusement,  literary,  predatory,  criminal,  etc.),  eflfects 
of  on  child  Tendencies  toward  loafing,  vagrancy,  migration. 

Recreation  facilities  of  neighborhood:  playgrounds,  public,  private, 
supervised,  unsupervised,  streets,  home  yard,  athletic  field,  gymnasium, 
social  settlement  house.  Seeks  what  kinds  of  amusements  (games, 
plays,  loafing,  running  around,  ball,  gambling,  crap  playing,  immoral 
practices,  selling  papers,  theaters,  picture  shows,  etc.).  Plays  with 
boys  or  girls,  older  or  younger.  Attends  picture  shows  or  theaters, 
how  often  What  kind  of  shows  preferred 

Effects  of  on  child 

Recommendations  : 

Results  of  Recommendations  (from  later  investigations): 

Signature  : 


SCHEMA  FOR  CLINICAL  STUDY 


437 


FORM  IV 

SCHOOL  HISTORY 

Teachers'    Reports    on    Pedagogical,    Psychological,    Social    and 
Moral  Traits 

No.  Diagnosis                  Reported  by  (with  position) 

Date  Full  name                                    Sex 

Age:  yrs.  mos.            Birthday                                       Address  (with 

'phone)  Parents'  or  guardian's  name   (and  address, 


if  difiPerent  from  child's) 
and  religion  of  father 
Language  spoken  in  child's  home 


Nationality,  language 
mother 
By  whom  referred 


(Underscore  appropriate  words :  once  for   'moderate,'   twice  for  'marked,'  and 
thrice  for  'extreme'  degree.    Also  fill  in  data  in  blank  spaces.) 

Attendance   Record:   Age  on  entering  first   school    (kindergarten 
included) 


Names  of  schools 

attended,  in 
correct  time  order 

Location  of 
School 

Time, 
from     to 

No.  of 
months  in 
attendance 

Grades 
completed 

Grades 
repeated 

(1) 
(2) 
(3) 
(4) 

Bepetitio7i:  number  of  months  spent  in  each  grade  child  has  repeated 

Total  time   (years  or  months)   spent 
repeating  work  Retardation:  grade  in  which  child 

should  be  according  to  age  Present  grade 

Amount  of  pedagogical  retardation  (yrs.  and  mos.) 
Attendance,    regular    or    irregular,    during    past    or    jiresent    time 
(ascribed  causes  of  irregularity) 

Past  Record:  character  of  work,  conduct,  disposition,  traits,  etc., 
as  reported  from  previous  teachers  or  specialists 

Present  Pedagogical  Status:  School  efficiency  in  general:  excellent, 
good,  fair,  poor,  very  poor,  total  failure.     Prospects  of  promotion: 
excellent,  good,  fair,  poor,  none.     Poorest  work  in  which  branches 
Best  work  in  which  branches 


438    MENTAL  HEALTH  OF  SCHOOL  CHH^D 

Special  aptitudes,  what  Greatest  interests,  or  likes,  in 

school  work  Greatest  dislikes 

Pedagogical  traits  in  which  strongest  In  which 

most  deficient  Learning  capacity:  is  child  good 

or  poor  in  ability  to  observe  to  concentrate 

to   memorize    (mechanically,   logically,   understandingly) 
to  retain  to  express  orally  or  in  writing  to 

form  habits  to  adapt  self  to  new  or  changing  situations, 

conditions  or  emergencies  to  think,  judge,  reason,  under- 

stand to  do  independent  work  to  lead 

to  direct  to  originate,  invent  to  keep  a  level 

head  (easily  confused)  Learns  best  by  repetition,  rote, 

memorizing,  reasoning,  imitation,  reading,  being  told,  doing  or 
experimenting  for  self  (hit  or  miss).  Accom'plishments :  in  reading: 
knows  alphabet  (letters  not  known)  reads  in  what 

reader  how  well  reads  at  sight,  syllables,  short 

words,  long  words,  spells  out  words  In  arithmetic ; 

counts,  how  far  Ability  in  addition,  subtrac- 

tion multiplication  division 

problems  How  far  advanced  Best  in 

concrete  or  abstract  work  In  spelling;  sample  words 

child  can  spell  Words  child  cannot  speU  In 

writing  In  drawing  In  grammar  In 

language  work  In  speaking,  dramatizing 

In  music  In  kindergarten  In  manual  train- 

ing In  shop  work  In  domestic  science 

In  school  gardening  In  gymnastics,  games  In 

history  In  geography  Ability  of  brothers 

of  sisters 
Reported  defects  or  capacities  of  mother 
of  father 

Attittjde  Toward  Schooi,  Work:  interested,  willing,  tries,  indus- 
trious, energetic,  cheerful,  trustworthy,  lazy,  slovenly,  careless,  shirk- 
ing, despairing,  diffident,  non-persevering,  easily  wearied  or  fatigued, 
grows  sleepy,  dopey,  disinterested,  bored,  inattentive,  complaining. 

Attitude  Toward  Correction,  Reproof  or  Punishment:  heedless, 
resentful,  headstrong,  obstinate,  talks  back,  abusive,  sensitive,  cries, 
indiflPerent.  Very  responsive,  tries  to  improve,  takes  it  with  good 
grace. 

Attitude  Toward  Plays  and  Games:  seeks  or  avoids  games.  Plays 
much  or  little.     On  playground  Plays  with   boys  or 

girls  with  younger  or  older  children 


SCHEMA  FOR  CLINICAL  STUDY  439 

Fond  of  what  games  or  plays  Plays  make-believe 

plays  ability  to  plan  or  lead  games 

Gets  confused  in  games  Loses  self-control 

Behavior  in  games 

Mental,  Morai  and  Social  Teaits:  Circumspect,  deliberate, 
thoughtful,  thoughtless,  impulsive,  careless,  slothful,  slovenly,  lazy, 
inert,  slow,  dull,  stupid,  apathetic,  unresponsive,  taciturn,  reticent, 
diffident,  retiring,  bashful,  quiet 

Bright,  talented,  precocious,  quick,  responsive,  talkative,  loquacious, 
communicative,  entertaining,  boring 

Cheerful,  good-natured,  gay,  humorous,  kind,  affectionate,  sympa- 
thetic, helpful,  generous,  frank,  obedient 

Moody,  sensitive,  despairing,  fretful,  cranky,  resentful,  malignant, 
defiant,  angry,  meddlesome,  complaining,  quarrelsome,  trouble  maker, 
brutal,  fights,  kicks,  scolds,  nags,  spiteful,  jealous,  sullen,  selfish, 
self-centered,  proud,  domineering,  bossy,  changeable  moods,  capricious 
disposition  or  character 

Graceful,  artistic,  neat,  awkward,  clumsy,  poor  gait,  poor  motor 
control,  stumbles,  falls,  injures  self 

Bold,  reckless,  heedless  of  danger,  venturesome,  blustering,  noisy, 
fearsome,  cowardly 

Restless,   fidgety,   nervous,   scowls,   twitching   movements    (of   what) 
excessive    movements,   emotional,   excitable, 
impulsive,  passionate,  violent 

Strange  or  peculiar  actions,  habits,  speech  (what) 
Sudden  or  capricious  outbreaks  of  passion,  anger,   fear,  destructive 
tendencies,    love,    gaiety,    laughing,    crying,    tantrums,    fits,    fainting 
spells.    Automatic  actions  (when  excited  or  otherwise) 
Suspicious,    solitary,    seclusive,    shut-in,    avoids    company,     dreamy, 
observant 

Honest,   truthful,    pure,    modest;    dishonest,    untruthful,    steals,    lies, 
profane,  swears,  obscene,  lewd,  masturbates,  immoral 
Any  sense  of  shame,  of  difference  between  right  and  wrong,  of  guilt, 
remorse,  sorrow,  reverence,  religion 

Speech:  stutters,  stammers,  lisps,  lalls,  indistinct,  inarticulate, 
sluggish,  mumbling,  thick,  incoherent,  halting,  jerky,  rambling,  point- 
less, labored;  clear,  fluent,  logical,  sensible,  braggadocious,  egotistical, 
gossipy;  declaims,  recites,  sings 

Headaches,  eyestrain,  holds  eyes  near  work,  mouth  open,  poor  hearing, 
takes  cold  easily,  running  nose,  gets  sick,  tired 
Smokes,  chews.    Data  from  school  medical  record: 


440    MENTAL  HEALTH  OF  SCHOOL  CHILD 

What  special  measures   have   been   taken   to  overcome   the  child's 
pedagogical  deficiencies  ? 
To  overcome  his  physical  defects 
His  moral  or  social  shortcomings 

Results  of  These  Measukes: 

Recommendations  : 

Results  of  Following  Recommendations   (from  later  inquiries): 

Signature  : 

FORM  V 
PHYSICAL  AND  ANTHROPOMETRIC  EXAMINATION 

No.  Diagnosis  Examiner  Date 

Full  name  Sex  Birthday 

Age:  yrs.  mos.  Address  Parents'  or 

guardian's  name  (and  address,  if  different,  with  'phone) 

Brought  by  Referred  by 

(Underscore  appropriate  words:  once  for  'moderate,'  twice  for  'marked,'  and 
thrice  for  'extreme'  degree.    Supply  all  relevant  data  in  blank  spaces.) 

Defects,  Diseases,  Disorders  and  Stigmata 
(Anatomical,  physiological,  neurological) 

General   Appearance:   Expression  nutrition 

Fat,  corpulent,  lean,  emaciated,  fair,  normal. 

Skin:  complexion;  pallid,  saUow,  ashen,  oily,  moist,  dry,  leathery, 
wrinkled,  baggy,  florid,  scars,  birthmarks. 

Teeth:  carious   (number,  degree)  roots,  tartar, 

impacted,  irregular,  malocclusion,  rachitic,  serrated,  pointed,  Hutch- 
inson's Gums 

Tongue:  thick,  pointed,  large,  small,   furrowed,   enlarged  papillae. 

Throat:  tonsils,  enlarged,  atrophied,  submerged,  pitted,  soft, 
removed.  Pharyngitis.  Laryngitis.  Mouth  breather.  Lymph  glands. 
Thyroid,  enlarged,  atrophied.    Adenoids. 

Palate:  cleft,  V-shaped,  arched,  narrow. 

Lips:  normal,  hare-lip,  thick,  thin,  everted,  fissured. 

Nose:  deflected  septum,  enlarged  turbinates,  polipi,  rhinitis,  broad 
base,  sunken  bones,  squat,  mongoloid,  cretinoid. 

Eyes:  acuity,  R  L  Astigmatism  Small 

palpebral  fissure,  exophthalmos,  choked  disc,  scotoma,  heraiopsia, 
irregular  or  eccentric  pupils,  ptosis,  oblique  mongolian,  epicanthus. 


SCHEMA  FOR  CLINICAL  STUDY  441 

Nystagmus,  strabismus,  diplopia,  accommodation  to  light  to 

distance  Argyll-Robertson 

Iris,  color,  R  L  Wearing  proper  or  improper  glasses 

Ears:  acuity,  R  L  Rinne  Otitis  media, 

R  L  Impacted   cerumen,   perforated   drum,   otorrhea. 

Large,  small,  Darwinian  tubercle,  lobule  absent,  fossae  absent  or  irre- 
gular, pinna  (size,  shape)  asymmetries 

Face:  immobile,  mobile;  forehead,  Bomb6,  receding,  low  or  narrow; 
prognathous  jaws,  asymmetries 

Head:  hydrocephalic,  macrocephalic,  microcephalic,  rachitic,  syphi- 
litic, cretinoid,  asj^mmetries.  Hair:  color  coarse,  dry,  oily, 
scant,  brittle.     Pediculosis. 

Shoulders:  round,  square,  stooped,  asymmetrical.    Scaphoid  scapula 

Spine:  scoliosis  C  D  L  lordosis,  C  D  L 

kyphosis 

Chest:  flat,  rachitic,  pigeon,  funnel,  barrel-shaped,  asymmetrical. 
Lungs  Respiration,  rate  character 

Upper  Limbs: 

Lower  Libibs: 
Flat  foot 

Circulation:  good,  poor.  Heart:  dilation,  murmurs,  displacements. 
Pulse:  volume  rate  rhythm  pressure  Veins 

Arteries  Blood  examination:  red  corpuscles 

white  corpuscles  hemoglobin  color  index 

Widal  Wasserman 

Alimentation:  appetite  digestion  abdomen 

stomach  intestines 

Genito-Urinart  System: 

Neuro-Muscui-ar:  tone,  relaxed,  flabby,  tense.  Corrugation,  over- 
action  of  frontals.  Tremors,  coarse,  fine,  unilateral,  spastic,  jerky, 
intermittent,  rhythmical,  of  what  parts  Hand  balance: 

relaxed,  tense,  drooping,  asymmetrical,  finger  twitches  Station: 

relaxed,    unsteady.      Head    balance  Gait:    normal,    lively, 

clumsy,  shuffling,  spastic,  ataxic,  waddling.     Paralyses 
Contractures  Fainting  spells  Tics 

Habit  spasm  Convulsions  Chorea 

Epilepsy  Hysteria  Headache,  migraine 

Anesthesias 

Reflexes:   patellar,   R  L  Clonus  Babinski 

Other  reflexes  Defective  speech 

Other  Defects  or  Stigmata: 


442    MENTAL  HEALTH  OF  SCHOOL  CHILD 

Active  Disease  Processes:  record  the  diseases,  and  indicate  whether 
slight  or  serious,  of  the  integumentary,  skeletal,  muscular,  nervous, 
nutritive,  respiratory,  circulatory,  lymphatic,  excretory  and  repro- 
ductive systems. 

History  of  Diseases,  Deformities  and  Accidents,  with  Previous 
Medical  Diagnoses: 

Name  of  Examiner: 

Physician's  Recommendations: 

Results  of  Recommendations  (as  later  ascertained) : 
Physician  or  hospital  recommended: 

Anthropometric  Measurements 

Weight:  lbs.  kg.  Stature,  net  standing  (mm.) 

Sitting  Ponderal  index  Statural  index 

Statural  type  Spread  of  arms 

Spirometry:  13  3  Chest  girth  (below  level  of  axillae): 

maximal  inhalation  exhalation  normal  Vital  index 

Dynamometry:  Rl  2  3  LI  2  3  Head 

measurements:  circumference  height  length   (antero- 

posterior diameter)  breadth  cephalic  index 

Other  measurements 

FORM  VI 

PSYCHOLOGICAL  EXAMINATION 

It  has  been  deemed  wise  to  omit  a  schema  for  conducting  psycho- 
logical examinations  for  the  following  reasons.  First,  a  considerable 
number  of  graded  scales  for  testing  intelligence  (particularly  versions 
of  the  Binet-Simon  scale)  are  now  easily  accessible  in  English. 
Second,  hundreds  of  different  psychological  tests  and  experiments  are 
equally  accessible  in  the  standard  books  dealing  with  psychological 
tests  (e.g.,  the  manuals  by  Whij^ple,  Franz,  Titchener,  Sanford, 
Starch,  Scripture).  It  would  be  futile  to  attempt  to  print  a  selected 
list  of  such  tests  here,  because  the  expert  experimental  psychologist 
is  qualified  to  make  his  own  selection,  while  the  inexperienced 
psychologist  (physician,  nurse,  teacher)  would  scarcely  be  able  either 
properly  to  conduct  the  experiments  without  technical  training,  or 
elaborate  explanations,  or  correctly  to  interpret  the  findings.  Third, 
there  is  little  profit  in  outlining  a  comprehensive  series  of  tests  until 
reliable  clinical  norms  are  available.  Unfortunately  such  norms  are 
not  yet  available.     The   fact  that  this   is   so  makes   it  all  the  more 


SCHEMA  FOR  CLINICAL  STUDY  443 

necessary  that  the  clinical  psycho-educational  examiner  should  possess 
very  extensive  first-hand  experience  with  many  types  of  mentally 
unusual  children,  so  that  he  will  be  able  to  diagnose  cases  fairly 
accurately  with  the  aid  of  a  minimal  number  of  tests. 

FORM  VII 

PEDAGOGICAL  EXAMINATION 

Until  we  have  available  a  series  of  clinical  pedagogical  age-norms, 
in  various  school  studies,  established  by  objective  tests  given  under 
standard  and  controlled  conditions,  possibly  to  individuals  rather 
than  to  groups — such  as  the  Courtis  scores  in  the  fundamental  mathe- 
matical processes,  though  these  are  group  norms — it  would  be  of 
little  avail  to  outline  a  schema  for  the  pedagogical  testing  of  the  child. 
We  have,  to  be  sure,  the  pedagogical  scales  by  Vaney  and  Holmes, 
but  the  former  is  very  limited  in  range  and  not  entirely  appropriate 
to  pupils  trained  by  American  school  methods,  while  the  latter  has 
not  been  experimentally  derived  by  objectively  testing  individual 
children  of  various  ages  (the  method  of  derivation  is  not  revealed). 
It  is  merely  an  abbreviated  course  of  study  for  grades  two  to  five 
which,  it  is  assumed,  represents  the  pedagogical  accomplishments  of 
normal  children.  Until  we  possess  satisfactory  pedagogical  age  scales 
of  development,  it  will  be  necessary  to  use  (but  with  discriminating 
judgment)  the  school  record  of  the  child  (Form  IV). 

FORM  VIII 

SUMMARY  OF  IMPORTANT  FINDINGS 

It  is  very  desirable  that  social  or  field  workers  epitomize  for  the 
busy  examiner  the  chief  findings.  This  blank  should  be  comprehen- 
sive, yet  very  brief:  it  should  contain  only  the  data  which  seem  to 
have  an  important  bearing  on  the  case,  which  are  important  for 
diagnosis  and  prognosis.  It  may  also  include  the  chief  results  of  the 
physical,  anthropometric  and  psychological  examinations,  the  final 
(or  at  least  the  provisional)  diagnosis,  the  recommendations,  a  record 
of  treatment,  the  results  of  treatment,  and  the  final  disposition  of  the 
case. 

The  question  naturally  arises  whether  it  is  necessary  or 
indeed  desirable  to  make  such  an  exhaustive  investigation 
of  each  case  as  that  contemplated  by  the  above  schema. 


444    MENTAL  HEALTH  OF  SCHOOL  CHILD 

The  answer  is  that  it  is  usually  desirable,  but  not  always 
necessary  or  possible  to  do  so.  Unless  the  clinicist  has  at 
his  command  the  necessary  staff  of  assistants  he  must 
content  himself  with  a  far  less  thorough  investigation.  He 
should,  however,  at  all  times  attempt  to  secure  a  certain 
minimum  of  data  which  bear  significantly  upon  psycho- 
educational  cases.  Such  a  minimum  is  represented,  I 
believe,  by  the  following  abbreviated  record  blank.  It  is 
reproduced  from  the  routine  blanks  which  have  been  in 
constant  use  in  my  clinic  for  several  years. 

FORM  IX 

ABRIDGED  RECORD  BLANK 

Child's  name  (with  street  and  city  address  and  'phone) 
Parents'  names   (with  address  and  'phone,  if  different) 
Referred  by  Brought  by  Date 

Data  secured  from  Recorded  by 

Exact  age:  date  of  birth  Age  in  yrs.  and  mos. 

Place  of  birth  Nationality  of  father  of  mother 

Language  spoken  at  home 

I.  Pedagogicax  Record 

School  now  in  All  schools  attended,  in  correct  time 

order,  with  dates 

Age  on  entering  first  school  (including  kindergarten) 

Number  of  years  (or  months)  in  school  Present  grade 

In  what  grade  should  child  be  according  to  age  Years 

retarded  Number  of  years   (or  months)   in  each  grade 

(including  kindergarten) 

Grades  repeated  (indicate  whether  one,  two  or  three  years) 

Will  child  be  promoted  this  year  Attendance 

Greatest  capacities,  abilities  or  talents  shown  in  school  work   (best 

subjects)  Greatest  interests 

Greatest  deficiencies,  worst  faults,  poorest  school  subjects 

Physical,  mental   and  moral  characteristics,   disposition,   deportment 

Other  comments  by  teachers 
School  medical  inspection  record 
School  record  of  brothers  and  sisters 


SCHEMA  FOR  CLINICAL  STUDY  445 

II.  Home  and  Environmental  Conditions 

Parents  alive  Living  together  Breadwinner 

(who)  Financial   conditions  Home   sanitary, 

well  ventilated,  clean  In  house,  tenement,  shack,   apart- 

ment In  good  or  bad  (slummy  or  immoral)  neighbor- 

hood Social  or  moral  conditions  in  home 

Home   treatment    (child   neglected,   cruelly   or   kindly   treated,   well 
cared  for)  What  does  child  usually  eat 

What  does  child  drink  Hours  of  retiring  and 

arising  Does  child  keep  bad  company 


III.     Child's  Developmental  History 

Birth  conditions:  on  time  premature  (how  much) 

Labor,  how  long  With  instruments  Birth 

injuries  How  nursed  (length) 

Health  as  babe  Infant  and  child  diseases   (state  age, 

severity,   after  effects) :   Croup  Whooping  cough 

Chicken-pox  Measles  Diphtheria  Scarlet 

fever  Typhoid  Pneumonia  C.-s.   menin- 

gitis Infant  paralysis  Spasms   (describe) 

Enuresis  Accidents  By  whom  previously  examined 

and  diagnoses  given 

First  teeth,  when  (any  illness)  Fontanel  closed 

First  stood  alone  First  sat  up  First  steps  unsup- 

ported First  walked  unsupported  First  used  single 

words  Short  phrases  or  sentences 

Mental  and  physical  peculiarities  in  infancy  and  childhood  (age 
first  observed):  queer  or  unusual  behavior,  talk  or  ideas;  emotional 
fits  or  outbreaks,  fears,  night  terrors,  destructive,  disobedient, 
vagrancy,  truancy,  veracity,  delinquencies,  bad  sex  habits,  social 
traits,  play  tendencies,  stupid,  sluggish,  quick,  bright 


IV.     Hereditary  Factors 

Health,  habits,  diseases,  drink,  etc.,  of  father  and  mother  before  and 
during  conception 

Pregnancy  conditions  (overwork,  poor  health,  infection,  drink, 
abuse,  starvation,  etc.) 

Age  of  mother  at  child's  birth  of  father  Parents 

related 


446    MENTAL  HEALTH  OF  SCHOOL  CHILD 


-a  M 

03 


c  ^ 


Order  of  child's  birth 


Number  of  Sisters 
Number  of  Brothers 


Give  facts  in  regard  to  the  following  defects,  conditions  or  diseases 
found  in  the  child's  brothers,  sisters,  mother,  father,  maternal  and 
paternal  great-grandparents,  grandparents,  amits,  micles,  first  and 
second  cousins,  etc.: 


03  a  0) 

<u  rt  bo 


[  Copies  of  the  preceding  Schema  are  available  in  separate  reprints,  and 
can  he  secured  from  the  publishers.] 


Note  to  Chapter  IV 

Some  unwarranted  assumptions  and  criticisms  relating 
to  the  original  of  this  chapter  by  one  of  my  reviewers  caU 
for  a  brief  refutation  (E.  A.  Doll,  The  Training  School 
BuUetin,  March,  1914,  10). 

'Possibly  Dr.  Wallin  has  again  confused  cause  and 
effect.'  My  critic  assumes  (he  gives  no  facts  in  support  of 
the  indictment)  that  my  diagnoses  are  purely  'diagnoses 
by  symptoms,'  and  that  I  confuse  the  facts  of  etiology  with 
the  facts  of  symptomatology.  A  perusal  of  the  article 
will  show  that  it  was  explicitly  affirmed  that  my  'final 
diagnosis  was  based  on  all  the  available  facts,'  facts  of 
etiology  and  pathology  no  less  than  facts  of  symptomatol- 
ogy. The  symptomatological  classification  was  not  based 
purely  on  symptoms,  as  the  word  would  indicate  unless 
proper  regard  were  given  to  the  statement  made  in  the 
text. 

'Dr.  Wallin  believes  that  the  percentage  (of  the  feeble- 
minded) is  below  rather  than  above  1  per  cent,  and  yet  he 
states  that  "over  10  per  cent  of  all  the  elementary  pupils 
in  the  Pittsburgh  public  schools  are  retarded  three  years 
or  more."  This  looks  very  much  like  a  contradiction,  since 
feeble-mindedness  is  defined  psychologically  as  intellectual 
retardation  of  two  years  at  an  age  below  nine  or  three 
years  at  and  above  nine,  which  definition  the  author 
admits  in  his  Experimental  Studies.'  My  reply  is  threefold. 

First,  I  do  not  admit  this  definition.  The  statement  I 
made  in  the  Experimental  Studies  (pp.  16,  98,  103)  was 
that  'children  retarded  less  than  three  years  should  prob- 
ably  not   be    rated    as    feeble-minded.'      Since    only    nine 


448    MENTAL  HEALTH  OF  SCHOOL  CHILD 

epileptic  children  were  retarded  less  than  three  years,  while 
the  average  retardation  for  the  epileptics  who  were  classi- 
fied as  children  was  over  seven  years,  I  had  little  need  of 
attempting  to  apply  automatically  any  rigid  'two-  or 
three-year  standard'  of  feeble-mindedness.  In  the  Prac- 
tical Guide  (p.  116f.)  I  was  careful  to  avoid  laying  down 
any  arbitrary  standard  whatever.  My  experience  with 
epileptic  and  insane  patients  had  aroused  my  suspicion  of 
the  propriety  of  so  doing.  My  later  experience  with  the 
great  variety  of  cases  which  come  to  a  university  clinic 
has  convinced  me  that  it  is  futile  to  attempt  a  differential 
diagnosis — even  to  the  extent  of  differentiating  between 
morons  and  backward  persons — on  a  confessedly  artificial 
and  arbitrary  quantitative  standard  of  intellectual  retar- 
dation. In  the  1911  scale  Binet  himself  wisely  avoids  this 
pitfall.  He  merely  states  that  no  child,  no  matter  how 
little  he  knows,  should  be  regarded  as  defective  unless  his 
intelligence  is  retarded  more  than  two  years.  Elsewhere 
he  cites  the  French  policy,  apparently  with  approval,  of 
not  placing  a  child  in  a  special  class  for  defectives  for 
mental  retardation  alone,  unless  the  retardation  amounts 
to  three  years  or  more,  or  to  at  least  two  years  if  the 
child  is  less  than  nine. 

Second,  the  retardation  statistics  I  gave  for  the  Pitts- 
burgh schools  refer  to  pedagogical  retardation  based 
merely  on  an  age-grade  census.  As  everybody  knows  these 
surveys  include  children  who  are  not  even  genuinely  back- 
ward in  inherent  all-round  mental  capacity.  I  merely 
ventured  the  opinion  that  one-half  of  the  10  per  cent 
retarded  three  years  or  more  should  be  placed  in  special 
classes,  but  assuredly  not  because  they  were  all  feeble- 
minded.     The   special   classes   in   the  public   schools    are 


NOTE  TO  CHAPTER  IV  449 

designed  not  only  for  the  feeble-minded  but  also  for  the 
seriously  backward.  Under  ideal  conditions  4  or  5  per 
cent  of  the  elementary  pupils  should  be  placed  in  these 
classes,  about  one-fourth  of  these  being  feeble-minded, 
about  one-fourth  border-line  cases  and  about  one-half 
seriously  backward. 

Third,  no  one  who  defines  feeble-mindedness  as  'intellec- 
tual retardation  of  two  years  at  an  age  below  nine,  or 
three  years  at  and  above  nine'  has  had  the  courage  to 
follow  this  definition  to  its  inevitable  conclusion.  It  is 
indeed  amusing  that  the  advocates  of  this  arbitrary  stan- 
dard tell  us  that  only  2  per  cent  of  the  elementary  school 
population  is  feeble-minded.  (Possibly  they  have  merely 
accepted  an  old  English  conjecture.  As  long  ago  as  1906 
Dr.  James  Kerr,  chief  medical  officer  for  the  London 
County  Council  Schools,  made  the  same  estimate  for  a 
committee  of  inquiry,  but  he  included  in  his  estimate  other 
types  of  mental  defectives  than  those  actually  feeble- 
minded.) Why  do  they  not  announce  that  8.4  per  cent  of 
the  grade  pupils  are  feeble-minded,  for  Goddard  found 
that  this  percentage  of  all  the  pupils  in  the  first  six  grades 
in  a  given  township  were  retarded  from  three  to  seven 
years  by  the  Binet  scale  .f"  Not  only  so,  if  we  assume  that 
one-fifth  of  those  retarded  two  years  were  'at  an  age 
below  nine,'  the  number  of  feeble-minded  would  be  10.4 
per  cent,  instead  of  8.4  per  cent — or  2  per  cent !  Are 
those  who  defend  the  'amazing  accuracy'  of  the  automaton 
method  of  diagnosticating  feeble-mindedness  prepared  to 
follow  their  method  to  its  inescapable  conclusion?  Are 
they  prepared  to  stand  'by  [their]  experimental  facts 
instead  of  preconceived  notions  as  to  possibility  or  impos- 
sibility'.?   Are  they  ready  to  present  incontestable  facts  to 


450    MENTAL  HEALTH  OF  SCHOOL  CHILD 

show  that  the  standard  which  they  adopt  is  not  itself 
nothing  but  a  'preconceived  notion'?  If  there  is  a  magic 
infallibility  about  this  standard,  why  do  they  not  formu- 
late the  standard  in  precisely  the  same  terms?  Doll  has 
one  standard;  Goddard  has  another,  to  wit:  'If  a  child  is 
more  than  two  years  backward  while  he  is  still  under  nine 
years  of  age,  .  .  .  .  he  is  probably  feeble-minded-  For  a 
child  above  nine  [how  about  the  nine-year  old?]  we  allow 
him  to  be  more  than  three  years  backward  before  we  call 
him  defective'  (italics  mine).  Does  more  than  three  years 
backward  mean  three  years  and  one  point  or  four  years? 
We  seek  in  vain  for  an  answer.  Contrast  this  standard 
with  Doll's  dictum  given  above  and  note  the  difference.  As 
I  have  frequently  stated  elsewhere  in  this  book,  my 
attempt  to  apply  arbitrary  quantitative  standards  of 
intellectual  retardation  in  the  diagnosis  of  the  varied  cases 
coming  to  a  university  clinic  in  a  populous  district  has,  in 
the  main,  proved  quite  futile.  I  have  had  numerous 
mentally  abnormal  cases  retarded  from  five  to  sixteen  years 
by  the  Binet  tests  whom  I  should  hesitate  to  call  feeble- 
minded. 


INDEX 


INDEX 


Abortion,  250,  261. 

Accelerated     pupils,     prevalence, 

105. 
Acceleration,  kinds,  101. 

Dedagogical,  7,  144. 
Adler,  34. 
Ages,  kinds,  101. 
Age-norms,  111,  229. 
standard  of,  204f. 
see  norms,  mental  norms. 
Age-scales,  kinds,  166f. 
Age     standards,     inequalities     in 

Binet,  202. 
Alcohol,  and  deficiency,  272f. 
and  heredity,  261. 
and    racial    deterioration,    258, 
266. 
American  productivity,  237. 
Amateur,  diagnosis,  379. 

psychological  diagnosis,  75,  137, 
142,  148,  151,  157f,  164,  209f, 
21  If,  218f,  220,  393f. 
testers,    75,    209f,    211f,    218f, 
220. 
Anatomical  age,   102. 
Anderson,  34,  75. 
Anthropometric,         examination, 
106f. 
norms,  184. 
record  blank,  440  f. 
Aphasic  imbecile,  342f. 
Arrest  of  development,  125f. 
Attendance,  causes  of  irregular, 

318,  320. 
Ayres,    105,    241f,   305,   311,    320, 
335f. 

Backward  children,  public  school 
classes  for,  384f,  387f. 
training  for,  386 f. 
see  feeble-minded,  mentally  ex- 
ceptional children. 
Backward   delinquent,  369f. 
Bailey  and  Babette  Gatzert  Foun- 
dation, 27. 
Beanblossom,  78. 


Behavior,   determination  of,   124. 

Benedickt,  131. 

Berry,  42. 

Binet,  229. 

Binet  testers,  role,  211f. 

in  schools,  393f. 

extent  of  training,  395. 

see  amateur. 
Binet-Simon,    curve    of   distribu- 
tion, 184f. 
Binet-Simon  scale,  139f,  173. 

accuracy    of,    143f,    173,    190f, 
201,  214f,  268,  449. 

advance  accrediting,  175,  191f, 
197. 

age  inequalities  in,  190,  202. 

automatic  diagnosis  by,  215. 

basis  of  accrediting,  175. 

coaching,  173f. 

difficult  ages,  191  f. 

discrepancies     in     rating,     49f, 
146f. 

edition  of  1908,  223f. 

exploitation  of,  140. 

functions  of,  141,  174. 

improvement  of,  226. 

inadequate  revisions,  223f. 

infallibility    of,    103,    143,    208, 
214f. 

methods  of  revision,  175. 

methods  of  testing  accuracy  of, 
143f,  190f,  196f. 

misconceptions  regarding,  141  f, 
209  f. 

mislocations  of  tests,  203f. 

number   of   tests   in   each    age, 
227. 

present  status  of,  196f. 

sources  of  inaccuracy,  190f. 

standards  of  passing,  204f. 

standardized        administration, 
226  f. 

time  to  administer,  114. 

valid  tests  of,  197. 

value  of,  141,  194,  205f,  215. 

wide-range  testing,  175f. 


454 


INDEX 


Binet-Simon    testing,    results    of, 

182f. 
Biographical  charts,  270f. 
Bismarck,  231. 
Blan,  241  f. 

Blind,  classes  for,  131,  426. 
Boas,  342. 
Bobertag,  117,  197. 
Boehme,   117. 
Bonus  system,  235. 
Bosworth,  34. 
Bottger,  84. 
Bowditch,  184. 
Brandeis,  235,  243. 
Breast  feeding,  251,  253. 
Breese,  34. 

Bricklaying  operations,  231. 
Bright  children,  classes  for,  427. 

physical  defects  of,  300f. 
Brill,  69. 

Browne,  238f,  243. 
Bruner,  41,  90,  219. 
Bryan,  303. 
Bureau  of  school  research,  89f. 

director  of,  94. 

possibilities  of,  93f. 
Burnham,  221. 
Business  efficiency,  236. 
Bunge,  261. 

Caffeine,   mental   effects   of,   240, 

272f. 
California     health     development 

law,  92f. 
Carriers,  anti-eugenic,  268. 
Cases,  basis  of  selection,  124. 
grouping  of,  125. 
for  psycho-clinicist,  160. 
Case  histories,  authors,  340f. 
Cattell,  74,  117,  236  f,  243. 
Causation,  kinds,  124. 

see  psychogenic  causation. 
Child  examiners,  requirements  of, 

92. 
Child  growth,  supervision  of,  253. 
Child,  orthogenesis,  246. 

see  orthogenesis,  orthophrenics, 
orthosomatics. 
Child  welfare  in  schools,  337f. 
Childs,  322. 

Chronological  age,  101. 
Classes    for    training    subnormal 
children,  67f. 


Classification,  educational,  160. 
inadequacy  of  pedagogical,  14, 

161  f. 
individual,  149. 
of  cases,  143f,  149f,  337f. 
of  subnormals,  14. 
Clearing      house,      psychological 
clinic  as,   lllf. 
in  schools,  101. 
Cleveland,  dental  experiment,  257, 
275  f,  291  f,  313. 
dental  squad,  172. 
Cleveland     schools,     dental     and 

medical  inspection  in,  315f. 
Clinic  cases,  337f. 
Clinical,     diagnosis,     220f      (see 
mental  diagnosis), 
method,  23,  115. 
norms,   from   group  tests,  215, 
220. 
Clinical  psychologist,  394. 
qualifications  of,  114f. 
research  functions,  220. 
training  needed,   134,  136,  142, 

210,  216f,  220. 
see        amateur       psychological 
testers 
Clinical  psychology,  20,  22f,  121  f, 
156f. 
aims,  123f. 
claims,  121. 
courses   in,  25f. 
and   education,  89  f. 
and    educational    psychologist, 

216,  220. 
and  experimental  psychologist, 

216,  220. 
field  of,  123. 

functions  of,  123,  137f,  182. 
and  genetic  psychology,  216. 
and  medicine,  54,  135,  159,  163. 
preparation  in,  115. 
and  the  psychologist,  55. 
relations  of,  132. 
relations     to     school     hygiene 

movement,  156f. 
standards  of,  211. 
and  the  teacher,  217f. 
Clinical  schema,  429f. 
Clinical  testing  technique,  222. 
Comnmnity,  conservation,  246f. 
orthogenesis,  294. 


INDEX 


455 


Compulsory    medical    treatment, 

17. 
Concord  reformatory,  78. 
Conservation,  231f,  246. 

child,  156,  294. 

human,  246f. 

of  mental  health,  337f. 

research  in,  270f. 

see  eflBciency. 
Contagious  diseases,  1. 
Coriat,  69. 

Cornell,  97,  301,  304f,  312,  335. 
Cornman,  242. 

Corrective   pedagogics,    117,    153, 
156,  159,  164f,  217,  339,  377f. 

see  orthogenesis,  orthophrenics, 
mental  hj^giene. 
Correlation,  method,  222. 

of  physical  and  mental  defects, 
7f. 
Courses,    in    clinical    psychology, 
25  f. 

on  exceptional  children,  25f,  71. 
Courtis,  241,  243. 
Criminal  municipal  courts,   Bos- 
ton, 75. 

Chicago,  399. 

Cleveland,  399. 
Criminality,  80,  166f,  180. 

and  heredity,  260. 

juvenile,  8f. 

study  of,  78f. 

see  defective  delinquent. 
Criminology,  Italian  school,  99. 
Cronin,   128,  313. 
Curve  of  distribution,  Binet,  184. 

normal,  109,  199. 

Davenport,  239,  243. 
Deaf,   131. 

classes  for,  425. 
Dearborn,  117. 
Dearborn,  W.  F.,  34. 
Decroly,  197. 
Defective  children,  menace  of,  9. 

delinquent,   366f. 

see  criminality. 
Defectives,  interest  in,  VII. 

vagueness  of  term,  386. 
Degand,  197. 
Delinquent  types,  366  f. 


Dental  defects,  evils  of,  334. 
prevalence  of,  2f,  329f. 
see  dental  hygiene. 
Dental  dispensaries,   free,  295. 
Dental    hygiene,    257,    275f,    291, 
313f. 
financial  value,  296f. 
graphs,  284f. 
mental    effects    of,    281  f,    288f, 

291  f. 
national  campaign  for,  276. 
values,  296. 
see  dental  defects. 
Dental  inspection,  statistics  from, 
334. 
in  Cleveland  schools,  315f. 
Dental  surveys,  328f. 
Dental  treatment,  effects  of,  332, 
334. 
see  dental  hygiene. 
Development     supervision,     253f, 

270. 
Developmental,  history,  98, 
norms.  111   (see  norms), 
record,  431  f,  445. 
Diagnosis,  differential,  141. 
mental,  123. 

psychological,   158    (see  educa- 
tional and  mental  diagnosis). 
Differential     pedagogical     treat- 
ment,   see    corrective    peda- 
gogics. 
Disciplinary   pupils,   classes    for, 

423f. 
Discrepancies    in    Binet    rating, 
175. 
see  Binet-Simon  scale. 
Doll,  71,  447,  450. 
Dubois,  63,  117,  130. 
Duncan,  260. 
Dynamometry,  171. 

Ebersole,  293,  336. 

Education    as    adjustment,    338, 

378. 
Educational    clinics,    in    schools, 
379. 
administrative  control  of,  379. 
see  psychological  clinics. 
Educational    diagnosis,    56,    138, 
340,  355,  378f,  393. 
see   mental    diagnosis,   psycho- 
logical examination. 


456 


INDEX 


Educational   orthogenesis,    125. 

see   corrective   pedagogics,   or- 
thophrenics. 
Educational     psychologist,     216, 

220. 
Educational  psychology,  and  clin- 
ical psychology,  136. 
Educational  waste,  337f. 
Educators,        as        psychological 
examiners,    396. 

see  Binet  testers. 
Efficiency,  age  curves,  199 f. 

individual  curves,  206. 

individual  and  group,  231f. 

pedagogical,  242. 

school,  240. 

in  school  organization,  337f. 

scientific,  231. 
Elementary      industrial     classes, 

387. 
Ellis,  79. 

Ellis  Island,  88f,  399. 
Elson,  336. 

Emerson,  H.,  234,  243. 
Emerson,  L.  E.,  70. 
Emery,  336. 

Environmental  blank,  435f,  445. 
Epilepsy,     131,     167,     169,     176f, 
182f. 

and  heredity,  260. 

mental     wreckage     from,     191, 
193. 

treatment  of,  357f. 
Epileptic   colonies,   psychological 

clinic  in,  70. 
Epileptic  curve,  factors  of,  186f, 
201  f. 

skewed  character,  190. 
Epileptic  imbecile,  356f. 
Epileptics,  143. 

classes  for,  423. 

distribution,  185f. 

intelligence  of,  186f,  188f. 

mental  deficiencies  of,  193. 
Etiology,  123. 
Eugenics,  240,  246f,  291. 

and  child  study,  258. 

diagnostic  difficulties,  267f. 

experimental  difficulties,  269. 

and  infant  mortality,  259f. 

and  instincts,  264f. 

legal  factors,  267. 

measures,  262f. 


obstacles,  263f. 

psychological  factors,  264f,  268. 
research  in,  270f. 
Euthanasia,  247. 
Euthenics,  246  f,  291. 

and  infant  mortality,  249f. 
Examination,  guide  for,  429f. 
of   subnormal   children,    school 

statistics  of,  392f. 
psychological,  2f,  12   (see  psy- 
chological    and     educational 
diagnosis    and   examination). 
Exceptional     children,     changing 
attitude  toward,  90. 
examination  of,   14f   (see  psy- 
chological    and  ^  educational 
diagnosis), 
types,  121. 
Exclusion  from  school,  and  phys- 
ical defects,  315f,  318f. 
Experimental  genetics,  269. 
Experimental   pedagogy,   depart- 
ment of,  100. 
Experimental    psychologist,    216, 

220. 
Experimental     psychology,     and 
clinical  psychology,  136. 

Family  charts,  98. 
Family  history  blanks,  433f,  445. 
Farrington,  73. 
Feeble-minded,  19,  112,  161. 

Binet  statistics  of,  133. 

colonization  of,  19. 

distribution  of,  186. 

need  of  oversight,  365f. 

prevalence  of,  148f,  447f. 

public    school    provisions    for, 
384f. 

school  efficiency  of,  169,  176. 

selection  of,  19. 

social  study  of,  166f,  180. 

study  of,  166. 

treatment  of,  125f. 

see  mentally  exceptional  chil- 
dren. 
Feeble-minded  institutions,  psy- 
chological study  in,  70,  382, 
399. 
Feeble-mindedness,  and  alcohol, 
261. 

definition  of,  447f. 

diagnosis  of,  133f. 


INDEX 


457 


diagnostic      difficulties,       161  f, 
450. 

and  epilepsy,  186f. 
and  heredity,  260. 

industrial       incompetence       of, 
168f,  178,  365f. 

institutional  provisions  for,  347. 

intellectual  arrest  of,  149f,  170. 

legal  questions  concerning,  166. 

menace  of,  19. 

nature  of,  125,  149f,  170. 

a  pedagogical  question,   125f. 

personal  efficiency  of,  167,  180. 

a  quantitative  variation,  386. 

standard  of,  188f,  450. 
Fernald,  Grace,  44. 
Fernald,  Guy  G.,  78. 
Fletcher,  35. 

Foreigners,  classes  for,  425. 
Form  board,  171,  343f. 
Forsyth  dental  clinics,  334. 
Foster,  117. 
Franz,  62,  70,  117. 
Free  dental  dispensaries,  11,  334. 
Free  dispensaries,  256. 
Free   dental   and   medical   treat- 
ment, 11. 
Freud,  62f,  69,  106,  130. 
Friend's  Asylum,  70. 

Galton,  184. 
Gantt,  235,  243. 
Gavler,   118,  302. 
Genius,  238,  260. 

schools'  duty  toward,  377f. 
George  Junior  Republic,  37. 
Gesell,  33,  51. 
Gilbreth,  231. 
Goddard,    38,    71,    118,    186,    197, 

202,  225,  239,  243,  449  f. 
Goldmark,  235. 
Greene,  336. 
Groszmann,  73,  120. 
Group,  results,  221. 

tests,  220. 
Growth  defects,  308,  310. 
Gulick,   118,  336. 

Haberman,  49. 
Hastings,  343. 
Haves,  237,  243. 
Healy,  34,  75. 
Heilman,  44,  306,  308. 


Heredity,  247f. 

blank,  433  f,  445. 

and  capacity,  262. 

and  environment,  98. 

investigations,     inaccuracy     of, 
430. 

of  talent,  237f. 
Hickling,  52. 
Hickman,  273. 
Hicks,  93. 
Hickson,   71. 

Hilfsschule  in  Germany,  390. 
Hill,  35,  79. 
Historiometry,  237f. 
Hoch,  69. 

Hollingworth,  240,  243. 
Holmes,  Arthur,  120,  336. 
Holmes,  W.  H.,  120. 
Holt,  249. 

Home  record  of  child,  435f,  445. 
Hospital  school,  24. 
Huey,  30,  72,  118. 
Human  efficiency,  231  f. 

study  of,   166f. 
Hygiene,  mouth,  240. 

see  dental  hygiene. 

Ideogenic  causation,  134. 

see  psychogenic  causation. 
Imbecile,  aphasic,  342f. 
excitable,  344f. 
mongolian,  347f. 
quasi-microcephnlic,  351f. 
in  schools,  341,  346. 
Immigrants,  and  illiteracy,  87. 

menace  of  defective,  89. 
Immigrant  stations,  and   psycho- 
logical diagnosis,  86f. 
Improvement,    measuring    scales 

of,  226. 
Incestuous  intercourse,  264f. 
Indices,  anthropometric,  184. 
Individual,  differences,  123,  282r. 

psychology,  20. 
Industrial    competency    of    sub- 
normals, 83. 
see        feeble-minded,        feeble- 
mindedness. 
Industrial    efficiency,    168f,    176, 

178. 
Industrial  scales,  226. 
Inebriety,   and   infant   mortality, 
250.* 


458 


INDEX 


Infant  mortality,  246f. 
causes,  249. 

euthenical  measures,  250f. 
factors,  273. 
reduction  in,  252f. 
Insane,  treatment  of,  130. 
Insane     hospitals,     psychological 

clinics  in,  68. 
Insanity  and  heredity,  260. 
Inspection,   medical   and  psycho- 
logical, IflF,  252. 
see  dental. 
Institutions    as    research    labora- 
tories, 73. 
Intellectual  efficiency,  170f,  176f. 
Intelligence,      of      feeble-minded 
and     epileptics,     see     feeble- 
minded and  epilepsy, 
measurement  of,  103. 
Introspective      psychology,      and 

clinical  psychology,  136. 
Isaacs,  35. 
Itard,  125. 

Janet,   130. 

JelliflPe,  69. 

Jessen,  333. 

Jones,  61,  69,  118,  130. 

Johnson,  38. 

Johnston,  71. 

Johnstone,  191,  197,  202. 

Jung,  62,  106. 

Jurisprudence     and     psychology, 
80. 

Juvenile  courts,  psycho-clinics  in, 
74,  383,  399. 

Juvenile  delinquents,  examination 
of,  76. 
problem  for  schools,  75f. 
see  criminality,  defective  delin- 
quent. 

Juvenile    Psychopathic    Institute, 
Chicago,  75. 

Katatonia,  207. 
Kaye,  262. 
Kellogg,  262. 
Kerr,  449. 
Keyes,  241,  244. 
Kiernan,  238,  244. 
Klein  Smid,  78. 
Kohnky,  314. 


Kraepelin,  69. 
Kuhlmann,  29,  72,  118. 

Laggards,  16. 

removal    from    regular    grades, 
16. 

see  backward  children,   feeble- 
mindedness,  retardation. 
Langmead,  210. 
Latenen,  261. 
Latent  complexes,  62f. 
Leslie,  93. 

Literacy,  tests  of,  87. 
Lombroso,  99. 
Longitudinal  analysis,  124. 
Lonnett,  261. 

Madigan,  52. 
McHenry,  336. 
MacMillkn,  90,  119. 
Marriage,  early,  260. 
eugenic,  262f,  264f. 
Maternal  diaries,  270. 
Mating,  eugenic,  291. 

factors  of,  265. 
Mean    variations,   between   Binet 

tests,  203,  206. 
Measuring    scales,    improvement 

of,  226. 
Medical  consultants,  159. 
Medical  inspection.  If,  255 f. 
administrative  control  of,  327. 
in  Cleveland  schools,  315f. 
defects  of,  255. 
functions  of,  1. 
indefinite     standards,     12,     97, 

322  f. 
problems  of,  95f. 
and     psychological     diagnosis, 
396f. 
Medical  record  blank,  440f,  445. 
Medical     and     psychological     in- 
spection   of   school    children. 
If. 
see   psychological   examination. 
Medical    schools,    psycho-clinical 

work  in,  49f. 
Medical  schools,  and  psychology, 

61. 
Medical  specialization,  339. 
Medicine,  and  clinical  psychology, 
135. 
see  clinical  psychology. 


INDEX 


459 


Memory  span,  in  epileptics,  193. 
Mendelism,  269. 
Mental  arrest,  134. 

see  feeble-mindedness. 
Mental  defectives,  scientific  train- 
ing of,  12. 
see    backward,    feeble-minded, 
mentally  exceptional  children. 
Mental  development  norms,  228. 
Mental  deviations,  12. 
Mental  diagnosis,  138 f,  209 f,  213, 
218. 
authoritative,  151. 
etiological,  152. 
fallacious,  161. 
individual,  149. 
and  medical  inspectors,  214. 
pernicious,  149. 

see   educational   and   psycholo- 
gical diagnosis. 
Mental    health,    conservation    of, 

337f. 
Mental  hygiene,  62f,  130,  182,  374. 

see  corrective  pedagogics. 
Mental  norms,  16,  215,  220f. 

see  age-norms,  norms. 
Mental,    testing,    inadequacy    of, 
219. 
traits,  unit  characters,  269. 
variations,  123,  125,  132,  138. 
wreckage  in  epileptics,  191,  193. 
Mentallj'^     exceptional     children, 
153. 
examination  of,  12,  17. 
school  provisions  for,  383f. 
treatment  of,  164. 
types  of  examiners  needed  for, 

164. 
see     backward,     feeble-minded 
children. 
Merrifield,  78. 
Method  of  testing,  190f. 
Methods     of    testing    measuring 

scales,  196f. 
Meumann,  119. 
Meyer,  30,  69,  130. 
Miner,  29. 
Mirick,  381. 

Misconceptions    regarding    Binet 
scale,  209f. 
see   Binet-Simon   scale. 


Misfit  pupils,  337f. 

see     backward,     feeble-minded, 
mentally      exceptional      chil- 
dren. 
Modifiability  of  behavior,  124. 
Mongolian  imbecile,  347. 

mentality  of,  349. 
Montessori,  126,  131,  343. 
Moron  types,  358f. 
Motor  scale,  178f. 

see  industrial  efficiency. 
Mouth    hygiene,    see    dental    hy- 
giene. 
Munro,  61,  119. 
Munsterberg,  119,  236. 

Narrow-range  testing,  175. 
National     Association      for     the 
Study    of    Exceptional    Chil- 
dren, 73. 
National  Dental  Association,  and 

oral  hygiene,  323. 
Native  capacity,  174,  227. 
Neurologist,  and  clinical  psychol- 
ogy, 217. 
and  psycho-educational  exami- 
nation, 158. 
Neurology,  134. 
New  Jersey,  care  of  exceptional 

children,  381. 
Newmayer,  304. 

New  York,  Laboratory  of  Social 
Hygiene    at    Bedford    Hills, 
78. 
Normal  age-norms,  229. 
Normal  child,  16. 
phvsically,  311. 
standard  of,  197f. 
Normal  norms,  108f,  229. 
Normal      schools,      psychological 

clinics  in,  44f,  58,  382,  399. 
Normal    variation,    standard    of, 

204. 
Normality,  criteria  of,  109. 
Norms,  clinical,  220f. 
half-yearly,  111. 
infant  and  adult,  110. 
mental  development,  171  f,  183f. 
pedagogical,  107. 
psychological.  111. 
see      mental      norms,      normal 
norms. 


460 


INDEX 


Observation,  method  of,  138f. 
Open-air  schools,  428. 
Oral  hygiene,  240. 

national  campaign  for,  328. 

see  dental  hygiene. 
Oral     orthogenesis,     see     dental 

hygiene. 
Orr,  336. 

Orthogenic    classes,    see    special 
classes. 

school,  24. 
Orthogenics,  159,  275,  312f. 

see  orthophrenics. 
Orthogenesis,  138,  182. 

infant,  246f. 

process  of,  125. 

program  of,  255f. 
Orthopedic  classes,  427. 
Orthophrenics,     125,     156,     159f, 
239f,  246,  289f,  291f,  313. 

measurement  of,  275,  292,  300f, 
312,  325. 

see  corrective  pedagogics,  men- 
tal  hygiene. 
Orthosomatics,     127f,     156,     239, 
246,  312. 

and  age  differences,  281. 

and  sex  diflPerences,  281. 

see  orthophrenics. 
O'Shea.  139,  238,  244. 
Osier,  293. 
Otis,  79. 

Parole,  76. 

Paschal,  78. 

Paternalism,  254. 

Pearson,  259. 

Phelan,  37. 

Physical   defects,   and   corrective 

pedagogic    treatment,    128. 
Pinard,  250. 
Precocity,  healthy  type,  375f. 

nervous  type,  374f. 

pathological  type,  372f. 
Premature  births,  250,  261. 
Prince,   69,   130. 

Prostitutes,    feeble-minded,    149. 
Public     institutions,     as     labora- 
tories, 180. 

research  bureaus  in,  89f. 
Public      schools,      conservational 
function,  270,  338. 

new  functions,  338. 


provisions  for  mentally  excep- 
tional children,  383f. 
psycho-educational     clinic     in, 

89  f. 
training  of  exceptional  chil- 
dren in,  68,  383f. 
Pupil  inspection,  see  dental  and 
medical  inspection,  psycho- 
clinical,  psycho-educational, 
and  psychological  examina- 
tion. 

kinds,   156f. 
Pupil  record  cards,  95f. 
Pseudo-experts,  161. 

see  amateur  testers. 
Psychasthenia,   150. 
Psychiatric  clinics,  152. 
Psychiatrist,     and    clinical    psy- 
chology, 217. 
Psychiatry,  132f. 
Psycho-analysis,  62f,  69. 
Psycho-clinical  examination,  aims 
of,  160. 
nature  of,  429 f. 
records,  lOOf. 

see   psychological   examination, 
clinical  psychology. 
Psycho-clinicist,  22,  124. 
Psycho-educational  clinics,  14,  21, 
138. 
contributions  of,  156. 
see   educational    and   psycholo- 
gical clinics. 
Psycho-educational         diagnosti- 
cians, 393f. 
see     educational     and     mental 
diagnosis. 
Psycho-educational        examiners, 
competent,  66. 
see    clinical    psychologist,    psy- 
chological examiners. 
Psycho-educational       laboratory, 
in  schools,  103f. 
functions,   106f. 
Psychogenic    causation,    62f,    69, 
130,  134. 
see  causation. 
Psychological     clinics,      14f,     21, 
]37f,  156f. 
affiliations  of,  58f,  93,  214,  397. 
clearing-house   function  of,   18, 
111,  121,  152f. 


INDEX 


461 


departmental  connections,  58f, 

93,  214,  397. 
enumeration  of,  57,  382,  399. 
functions    of,    113,    137f,    154, 

157f,  396. 
qualifications    of    director    of, 

113. 
research  functions,  154. 
spread  of,  23f. 
standards  of,  54f. 
statistics  of,  382,  399. 
and      supervision      of     special 

classes,  114. 
table  of,  399. 
teaching  function,  113. 
and  vocational  guidance,  113. 
see   psycho-educational   clinic. 
Psychological  clinics,  in  criminal 

courts,  75,  399. 
in     feeble-minded    institutions, 

70,  382,  399. 
in  immigrant  stations,  86f,  399. 
in  insane  hospitals,  68,  382,  399. 
in  juvenile  courts,  74,  382,  399. 
in    medical    schools,    58f,    382, 

399. 
in  normal  schools,  44f,  58,  382, 

399. 
in    penal   institutions,   78,   382, 

399. 
in    psychological    departments, 

27 f,  382. 
in  public  schools,  89f,  103f,  214, 

382,  397f. 
in  reformatories,  78,  382,  399. 
in    schools    of    education,    27f, 

58f,  382. 
in  universities,  27f,  57,  382,  399. 
in  vocational  guidance  bureaus, 

81. 
Psychological,  age,  102. 
development  norms,  269. 
diagnosis,  268,  396  (see  mental 

diagnosis). 
Psychological  examination.  If,  12, 

16f,  20,  87f,   lOOf,  105,  209f, 

255  f,  442. 
and    amateurs,    75    (see    ama- 
teur), 
misconceptions  regarding,  141  f. 
nature  of,  106. 
school  statistics  of,  393f. 
transcript  of,  18. 


whom  to  examine,  14,  16f,  104f, 

163. 
see  psycho-clinical  examination. 
Psychological   examiner,   training 
needed,  163f,  210f,  212f,  394f. 
Psychological  tests,  326. 

of   dental   hygiene,   275  f,   293f, 

313. 
of  physical  defectives,  309 f. 
Psychologist,       functions,       121f, 
137f,  156f,  182. 
position  in  institutions,  73. 
and    psycho-educational    diag- 
nosis, 158. 
Psychology,  applied,  22. 
clinical  value,  20. 
courses  in  medical  schools,  60f. 
scientific,  22. 
Psycho-neuroses,  63. 
Psychopathology,   133. 

and     psycho-clinical     examina- 
tion, 158. 
Psychotherapy,  62f. 
Psychotics,  incipient,  130. 
Pyle,  31. 

Qu^telet,  260,  343. 

Race,     conservation,     246f,     291, 
294,  298. 

improvement,  240,  258. 
Racial,   efficiency,  conservation  of, 
239. 

indices,  110. 
Rapeer,  4. 
Rate     of     mental     development, 

tests  of,  171f. 
Record  blanks,  431  f. 
Record  charts,  95. 
Records  of  physical  defects,  327. 

chaotic  condition  of,  323f. 
Reformatories,  psychological 

clinics  in,  78,  382,  399. 
Repeaters,  306. 
Repetition,  cost  of,  297. 
Reply  to  criticisms,  447f. 
Research  function  of  psychologi- 
cal clinic,  182. 
Retardates,  126,  133. 

average  defects  among,  307. 
Retardation,  296,  300f. 

causes,  102,  105,  330. 

and  dental  hygiene,  289,  291f. 


462 


INDEX 


kinds,  101. 
pedagogical,  144. 
and  physical  defects,  300f. 
prevalence  of,  91,  104f. 
see      backward      and      feeble- 
minded children. 
Revisions  of  Binet  scale,  223f. 
Rice,  242. 
Rogers,  70. 
Rosanoflf,  70. 

Rural   districts,    medical   inspec- 
tion in,  10. 
Russell  Sage  Foundation,  10,  15, 
108. 

Salaries,  of  special  class  teachers, 

400f,  418. 
Schafer,  260. 

Schema  for  clinical  study,  429f. 
Schlapp,  50. 
Schmidlapp  Bureau,  86. 
Schmitt,  Clara,  90,  119. 
Schmitt,  A.  Emil,  128. 
Scholarship,  and  physical  defects, 

301  f. 
School,    conservational    functions 
of,  254f. 

dentists  in,  10. 

dental  clinics  in,  240,  332f. 

dental  dispensaries  in,  lOf. 

efficient    organization    of,    241, 
253,  337. 

efficiency,  169,  176. 

feeding,  320. 

functions  of,  11,  16. 

hygiene,  156. 

inadequate  means  of  classifica- 
tion in,  14,  162. 

inspection,  1. 

medical  dispensaries,  9f. 

medical  inspection,  9f. 

nurses,  lOf,  317f. 

progress  and  physical  defects, 
310. 
Scoring,  method  of,  201f. 
Scott,  236. 
Seashore,  228. 
Sedgwick,  29. 
Segregation  of  unfit,  13,  257,  263, 

266f. 
Seguin,  125. 
Sex  diflferences,  281. 


Shop  management,  234f. 

Sidis,  69. 

Skewed  curve,  201  f. 

causes  of,  190f. 
Smedley,  107f,  184,  229,  309,  342. 

criticism  of  norms  of,  107f. 
Smith,  28,  75. 
Sneed,  336. 

Social  efficiency,  167f,  180. 
Social  factors,  98. 
Socio-industrial  age,  102. 
Sociological  data,  98. 
Southard,  34. 
Special  classes,  17f. 

cities  reporting,  388. 

efficiency    of    graduates    from, 
83. 

enrollment  per  class,  389f. 

functions  of,  448. 

in  higher  institutions,  68. 

methods  of  organization,  391. 

in  public  schools,  383  f,  405  f. 

supervision  of,  114. 

tabulation  of,  405f. 

teachers  in,  114. 
Special  class  teachers,  114. 

salaries,  400f,  418. 

standards  of  preparation,  401f. 

training  of,  400f,  419. 
Special   schools,   advantages   and 
disadvantages,  391  f. 

as  clearing  house,  112. 
Special  school  centers,  390. 
Speech  defectives,  129. 

classes  for,  426. 
Speech  development,  358f. 
Spelling  efficiency,  242. 
Standardized  technique,  226 f. 
Statistics,   of  dental  defects,  2f, 
329  f. 

of    physical    defects,    2f,    300f, 
321  f. 

of    special    classes     in     public 
schools,  383  f,  385,  405  f. 

of  psychological  clinics   (see). 
Sterilization    of    unfit,    239,    263, 

266f. 
Stern,  238,  244. 
Still  births,  261. 
Stoelting  Co.,  173,  278. 
Strayer,  241,  244. 
Stuttering,  theories  of,  129. 


INDEX 


463 


Subnormal  children,  104. 

classification  of,  14. 

examination  of,  408f. 

menace  of,  91. 

misfits  in  regular  grades,  390. 

prevalence  of,  90f. 

types,  341  f. 

see      backward      and      feeble- 
minded children. 
Suggestion,  62f. 
Sullivan,  261. 
Supernormal  children,  104,  128. 

schools'      obligations      toward, 
377. 

tjTJes,  372  f, 
Sylvester,  36. 

Symptoms,  diagnosis  by,  447. 
Syphilis,  260. 

Taboo,  eugenical,  264f. 
Tabulation      of      special      public 

school  classes,  405f. 
Talbot,  237,  244. 
Talent,  conservation  of,  236. 
Taussig,  324f,  336. 
Taylor,  61,  119. 

Charles   Keen,  272. 

Frederick  W.,  232. 
Teeth,  see  dental  defects,  dental 

hygiene. 
Terman,  31. 

Terman  and  Childs,  118. 
Testing,  inadequacy  of,  209,  213. 

of  measuring  scales,   196f. 

method  of,  190f. 

narrow-range  type,  197f. 

wide-range  type,  191. 
Tests,  necessary  number,  227. 

unreliability  of,  151. 

value  of,  139,  142,  151f. 
Thorndike,  222,  241,  247. 
Tobacco,  effects  of,  272f. 
Todd,  36. 

Town,  72,  119,  224. 
Training  psycho-clinics,  65f. 
Trait  norms,  228. 
Traits,  tests  for  individual,  171f. 
Tredgold,  260. 
Trettien,  30. 
Truancy,  8. 
Truants,  75f. 

classes  for,  423f. 
Tuberculosis,  260. 


Unfit,  elimination,  247. 
Ungraded  classes,  384f,  387,  402f, 
430  f. 

confused  functions  of,  402f. 

enrollment  permitted  in,  403. 

organization   of,   402f. 

teachers'  qualifications  in,  404. 
Universities,  psychological  clinics 
in,  22f,  382,  399. 

and  scientific  work,  74. 

Vagrancy,  8. 

Van  Sickle,  241,  244. 

Variation,   maximal,   205. 

normal,  197,  205. 
Vocational  bureau,   functions  of, 
81. 
misnomers,  85. 
Vocational  efficiency,  234f. 
Vocational  guidance,  blundering, 
358f,  361f,  365. 
and  psychological  diagnosis,  81, 
113.  ' 
Vocational  talents,  determination 

of,  85. 
von  Moltke,  231. 

Wagner,  119. 
Walker,  78. 

Wallin,   32,    119,   240f,  242,   244f, 
estimate  of  physical  defects,  5. 
Weidensall,  78. 
Weisenberg,  323. 
Wells,  70. 
Wernicke,  69,  260. 
Whethams,  237f,  245. 
Whipple,  37,  119. 
White,  52,  69. 

Wide-range  testing,  201,  225. 
Wile,   163. 
Williams,  69. 
Winch,  242,  245. 
Witmer,  23f,  27,  120f. 
Woodrow,  29. 
Woods,  237f,  245,  299. 
Woodworth,  237,  245. 
WooUey,  86,  120. 
Wylie,  70. 

Yerkes.  34. 
Young,  51. 

Ziehen,  69. 


8T 


1 


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